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Emergence of resistance as a consequence of antimicrobial prophylaxis in immunocompromised patients
Abstract:
Many authors in the literature have investigated the use of antibiotics in prophylaxis against infections in granulocytopenic patients. Two general methods have been used: one consists in trying to decontaminate the digestive tract in the hope of reducing the amount of microorganisms responsible for systemic infections. Another method is to use well-absorbed oral antibiotics, like trimethoprim-sulphamethoxazole, throughout the neutropenic period. It is considered critical to preserve as much as possible of the anaerobic flora, which is believed to provide protection against colonization by aerobic microorganisms or by fungi. Experimental and clinical evidence for this is critically reviewed. The efficacy of such methods has been variable, but there is also widespread fears that they could enhance selection of resistant organisms. We have reviewed the literature, specifically looking for data on the emergence of such resistant organisms, as well as data on changes in bacterial and fungal faecal flora.
Insights
Antibiotic prophylaxis in granulocytopenic patients shows variable efficacy. Concerns exist regarding the selection of resistant organisms and alterations in gut flora, necessitating careful review of existing data.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Antibiotic prophylaxis is used to prevent infections in granulocytopenic patients.
- Two main strategies include digestive tract decontamination and oral antibiotics like trimethoprim-sulphamethoxazole.
- Preserving anaerobic flora is considered crucial for preventing aerobic and fungal colonization.
Purpose of the Study:
- To critically review experimental and clinical evidence on antibiotic prophylaxis in granulocytopenic patients.
- To assess the emergence of resistant organisms due to these prophylactic methods.
- To analyze changes in bacterial and fungal fecal flora.
Main Methods:
- Literature review of studies on antibiotic prophylaxis in granulocytopenic patients.
- Focus on data regarding the selection of resistant microorganisms.
- Examination of studies detailing alterations in fecal flora composition.
Main Results:
- Efficacy of current prophylactic methods is variable.
- Widespread concerns exist about the potential for enhanced selection of resistant organisms.
- Data on changes in bacterial and fungal fecal flora were specifically reviewed.
Conclusions:
- The use of antibiotics for prophylaxis in granulocytopenic patients presents a complex balance between infection prevention and the risk of resistance.
- Further research is needed to optimize strategies that minimize the emergence of resistant organisms while maintaining protective gut flora.