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Selective bowel decontamination for the prevention of infection in acute myelogenous leukemia: a prospective
Dong Gun Lee1, Su Mi Choi, Jung Hyun Choi
1Department of Internal Medicine, Catholic University College of Medicine, Seoul, Korea.
Background:
Infection is still a frequent cause of morbidity and mortality in acute myelogenous leukemia (AML) patients receiving chemotherapy. Recently the main cause of infection has changed from gram-negative to gram-positive bacteria and the resistance to antibiotics has increased. This study aimed to access the effectiveness of antimicrobial prophylaxis (AP) with orally absorbable antibiotics.
Methods:
Ninety-five AML patients receiving chemotherapy at Catholic Hemopoietic Stem Cell Transplantation Center from March 1999 to July 1999 were randomly divided into the AP group (250 mg ciprofloxacin twice a day, 150 mg roxithromycin twice a day, 50 mg fluconazole once a day) and the control group for a prospective analysis.
Results:
The incidence of fever was 82.6% in the AP group and 91.6% in the control group (p = 0.15). Though classification and sites of infections showed no difference between the two groups, the catheter associated infection occurred more frequently in the AP group in significance. The time interval between initiation of chemotherapy and onset of fever, white blood cell (WBC) count at the onset of fever, duration of leukopenia (WBC < 1,000/mm3), duration of systemic antibiotic therapy, mortality due to infection and hospitalization period from the data starting chemotherapy showed no differences between the two groups. Infections due to gram negative bacteria decreased to 33.3% in the AP group (vs. 92% in the control group), but infections due to gram positive bacteria increased to 66.7% (vs. 8% in the control group). Gram negative bacteria showed 100% resistance to ciprofloxacin in the AP group and gram-positive bacteria showed 90-100% resistance to erythromycin, regardless of the presence of AP.
Conclusion:
The AP could not reduce the occurrence of infection or infection associated death in AML patients receiving chemotherapy. On considering increased gram-positive infection and resistance to fluoroquinolone and macrolide, routine prescription of AP should be reconsidered. Further studies that assess the effectiveness of AP in other malignancies, aplastic anemia and bone marrow transplantation are required.
Insights
Antimicrobial prophylaxis (AP) did not reduce infections or deaths in acute myelogenous leukemia (AML) patients undergoing chemotherapy. Increased gram-positive infections and antibiotic resistance suggest reconsidering routine AP use in AML treatment.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Infections are a major cause of morbidity and mortality in acute myelogenous leukemia (AML) patients undergoing chemotherapy.
- A shift from gram-negative to gram-positive bacterial infections and increasing antibiotic resistance complicate infection management in AML.
Purpose of the Study:
- To evaluate the effectiveness of oral absorbable antimicrobial prophylaxis (AP) in reducing infections and mortality in AML patients receiving chemotherapy.
Main Methods:
- A prospective randomized study involving 95 AML patients receiving chemotherapy.
- Patients were assigned to either an AP group (ciprofloxacin, roxithromycin, fluconazole) or a control group.
Main Results:
- No significant difference in fever incidence, infection sites, or mortality between AP and control groups.
- AP group showed a decrease in gram-negative infections but an increase in gram-positive infections.
- High resistance rates to ciprofloxacin and erythromycin were observed in gram-negative and gram-positive bacteria, respectively.
Conclusions:
- Antimicrobial prophylaxis (AP) did not reduce infection occurrence or infection-associated deaths in AML patients.
- Increased gram-positive infections and resistance to fluoroquinolones and macrolides necessitate reconsideration of routine AP.
- Further studies are needed for AP effectiveness in other hematologic conditions and transplant settings.