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[Clinical significance of gastrointestinal decontamination under protected environment]
T Nagao1, S Yonekura, M Komatsuda
1Fourth Department of Internal Medicine, School of Medicine, Tokai University.
Abstract:
Many infections are caused by the patient's own oro-intestinal microbial flora under a protected environment. Thirty-eight patients with acute leukemia and two patients with blast crisis of chronic myelocytic leukemia were treated under a protected environment with or without prophylactic antibiotics. Antibiotics used for decontamination were vancomycin (V), polymyxin B (P) and nystatin (N). The number of patients in the VPN, PN and the no antibiotic group were 13, 13 and 14, respectively. While the intestinal microbial flora was almost completely eliminated in VPN group, the number of bacteria decreased slightly in PN group. The mean number of pharyngeal and anorectal bacterial species decreased most markedly in the VPN group, but there were no significant differences among the three groups. The number of febrile days was significantly lower in the VPN and PN group than the no antibiotics group with neutrophil counts of less than 100 microliters. The average number of episodes of infection per patient was lowest in VPN group and highest in the no antibiotic group. These data indicate that VPN administration is effective for eliminating intestinal bacterial flora and resultantly protecting endogenous infections.
Insights
Prophylactic vancomycin, polymyxin B, and nystatin (VPN) effectively eliminated gut microbes in leukemia patients. This antibiotic regimen reduced infections and febrile days, protecting against endogenous infections.
Area of Science:
- Oncology
- Infectious Diseases
- Microbiology
Background:
- Endogenous oro-intestinal microbial flora can cause infections in immunocompromised patients, particularly those with leukemia.
- Protected environments are used to manage patients with compromised immune systems.
Purpose of the Study:
- To evaluate the efficacy of prophylactic antibiotics for decontamination in leukemia patients undergoing treatment in a protected environment.
- To assess the impact of antibiotic regimens on microbial flora and infection rates.
Main Methods:
- Thirty-eight acute leukemia patients and two chronic myelocytic leukemia patients in blast crisis were studied.
- Patients were assigned to three groups: vancomycin/polymyxin B/nystatin (VPN), polymyxin B/nystatin (PN), or no antibiotics.
- Intestinal microbial flora, pharyngeal and anorectal bacterial species, febrile days, and infection episodes were monitored.
Main Results:
- The vancomycin/polymyxin B/nystatin (VPN) regimen nearly eliminated intestinal microbial flora.
- The VPN and PN groups showed significantly fewer febrile days compared to the no-antibiotic group, especially in patients with low neutrophil counts (<100/µL).
- The VPN group had the lowest average number of infection episodes per patient.
Conclusions:
- Prophylactic vancomycin/polymyxin B/nystatin (VPN) administration is effective in eradicating intestinal bacterial flora.
- VPN decontamination protects against endogenous infections in leukemia patients.
- Antibiotic decontamination strategies can reduce infection morbidity in immunocompromised patients.