Selective bowel decontamination for the prevention of infection in acute myelogenous leukemia: a prospective randomized trial.
BACKGROUND
Infection is still a frequent cause of morbidity and mortality in acute myelogenous leukemia (AML) patients receiving chemotherapy. Recently the main cause of infection has changed from gram-negative to gram-positive bacteria and the resistance to antibiotics has increased. This study aimed to access the effectiveness of antimicrobial prophylaxis (AP) with orally absorbable antibiotics.


METHODS
Ninety-five AML patients receiving chemotherapy at Catholic Hemopoietic Stem Cell Transplantation Center from March 1999 to July 1999 were randomly divided into the AP group (250 mg ciprofloxacin twice a day, 150 mg roxithromycin twice a day, 50 mg fluconazole once a day) and the control group for a prospective analysis.


RESULTS
The incidence of fever was 82.6% in the AP group and 91.6% in the control group (p = 0.15). Though classification and sites of infections showed no difference between the two groups, the catheter associated infection occurred more frequently in the AP group in significance. The time interval between initiation of chemotherapy and onset of fever, white blood cell (WBC) count at the onset of fever, duration of leukopenia (WBC < 1,000/mm3), duration of systemic antibiotic therapy, mortality due to infection and hospitalization period from the data starting chemotherapy showed no differences between the two groups. Infections due to gram negative bacteria decreased to 33.3% in the AP group (vs. 92% in the control group), but infections due to gram positive bacteria increased to 66.7% (vs. 8% in the control group). Gram negative bacteria showed 100% resistance to ciprofloxacin in the AP group and gram-positive bacteria showed 90-100% resistance to erythromycin, regardless of the presence of AP.


CONCLUSIONS
The AP could not reduce the occurrence of infection or infection associated death in AML patients receiving chemotherapy. On considering increased gram-positive infection and resistance to fluoroquinolone and macrolide, routine prescription of AP should be reconsidered. Further studies that assess the effectiveness of AP in other malignancies, aplastic anemia and bone marrow transplantation are required.
Lee
Dong Gun
DG
Department of Internal Medicine, Catholic University College of Medicine, Seoul, Korea.
Choi
Su Mi
SM
Choi
Jung Hyun
JH
Yoo
Jin Hong
JH
Park
Yoon Hee
YH
Kim
Yoo Jin
YJ
Lee
Seok
S
Min
Chang Ki
CK
Kim
Hee Je
HJ
Kim
Dong Wook
DW
Lee
Jong Wook
JW
Min
Woo Sung
WS
Shin
Wan Shik
WS
Kim
Chun Choo
CC
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002939:Ciprofloxacin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D015725:Fluconazole / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced / Q000150:complications*; D011446:Prospective Studies; D015575:Roxithromycin / Q000627:therapeutic use; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D015575:Roxithromycin; D002939:Ciprofloxacin; D015725:Fluconazole