Antimicrobial prophylaxis in acute leukaemia: prospective randomized study comparing two methods of selective...

Area of Science:

• Infectious Diseases
• Hematology
• Microbiology

Background:

• Patients with acute leukemia undergoing remission induction therapy are at high risk for infections.
• Selective decontamination of the digestive tract (SDD) is a strategy to prevent infections in immunocompromised patients.

Purpose of the Study:

• To compare the efficacy of two different SDD regimens in patients with acute leukemia.
• To evaluate the impact of SDD on the occurrence of gram-negative infections and colonization.

Main Methods:

• A prospective randomized study involving 78 acute leukemia patients during remission induction therapy.
• Two SDD regimens were compared: Group A (cotrimoxazole, polymyxin B, nystatin) and Group B (nalidixic acid, polymyxin B, neomycin, nystatin).
• Gastrointestinal and oropharyngeal decontamination, acquired infections, and gram-negative bacteremia were monitored.

Main Results:

• Both regimens effectively decontaminated the gastrointestinal tract from potential pathogens.
• Regimen A demonstrated significantly better oropharyngeal decontamination of Enterobacteriaceae (P < 0.01).
• Fewer than 10% of acquired infections were caused by gram-negative bacilli in both groups, with no gram-negative septicaemia.
• The median time to the first acquired infection was shorter in Group A (17 days) compared to Group B (36 days) (P < 0.05).

Conclusions:

• Regimen A may be more effective than regimen B for selective decontamination of the digestive tract in acute leukemia patients.
• Both SDD regimens reliably prevent severe gram-negative infections.
• Targeted oropharyngeal decontamination is crucial in managing infection risk during leukemia therapy.