Problems and results of selective decontamination in leukemia patients

Infectious complications play a major part during the cytostatic treatment of patients suffering from acute leukemia, as well as in bone marrow transplantations. For infection prevention, the method of selective decontamination (SD) of the digestive tract was used. This procedure eliminates the potentially pathogenic aerobic bacteria and yeasts while leaving the anaerobic intestinal microflora unaffected. The protocol of the Gnotobiotic Project Group was used in treating 33 patients with SD and the results were compared with those from a comparable control group consisting of cases selected from files who had been treated without SD in the past. A statistical difference was obtained in favor of the SD patients regarding frequency and severity of infection, time between admission and the first signs of infection, days febrile, and in the additional necessity of antibiotics (p less than 0.01). SD involves in addition to a scheduled intake of tablets, microbiological surveillance, personal hygiene and an intact hemostasis, and optimal results can be obtained given the help of the patients' compliance. SD has won a secured place in treatment tailored upon the pathophysiological concept of infection prevention, even though there are problems remaining, e.g., gram-positive cocci, yeasts and infection of the oropharynx.