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Related Experiment Videos

Selective decontamination in bone marrow transplant recipients.

H F Guiot1, R van Furth

  • 1Department of Infectious Diseases, University Hospital, Leiden, The Netherlands.

Epidemiology and Infection
|December 1, 1992
PubMed
Summary

Selective decontamination (SD) prevents serious infections in bone marrow transplant patients. This strategy uses antibiotics to eliminate harmful bacteria and fungi while preserving beneficial gut flora, reducing infection risks.

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Area of Science:

  • Infectious Diseases
  • Hematology
  • Pharmacology

Background:

  • Bone marrow transplant patients experience profound immunocompromise due to conditioning regimens.
  • Deep granulocytopenia increases susceptibility to severe bacterial and fungal infections.
  • Selective decontamination (SD) is a strategy developed over 15 years to prevent these infections.

Purpose of the Study:

  • To describe the strategy of selective decontamination (SD) for preventing infections in immunocompromised patients undergoing bone marrow transplantation.
  • To detail the antibiotic regimens and their application in SD and systemic prophylaxis.
  • To report on the efficacy and remaining challenges of this approach.

Main Methods:

  • Standard SD involves oral antibiotics (neomycin, polymyxin B, pipemidic acid, amphotericin B) and local agents to eliminate aerobic Gram-negative rods, Staphylococcus aureus, and Candida spp.

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  • Systemic penicillin is administered intravenously to prevent streptococcal infections.
  • Alternative antibiotics like ciprofloxacin and cotrimoxazole are used selectively for persistent infections or when oral administration is not possible.

    • Main Results:

    • The combination of SD and systemic prophylaxis effectively reduces major infections.
    • The majority of anaerobic flora are preserved, supporting colonization resistance.
    • The primary remaining issue is mild catheter-associated infections caused by coagulase-negative staphylococci.

    Conclusions:

    • Selective decontamination combined with systemic prophylaxis is an adequate strategy for infection prevention in bone marrow transplant recipients.
    • This approach successfully targets key pathogens while maintaining gut barrier function.
    • Further management strategies may be needed for catheter-related infections.