Selective Antimicrobial Modulation of the Intestinal Microbial Flora for Infection Prevention in Patients with Hematologic Malignancies: Evaluation of Clinical Efficacy and the Value of Surveillance Cultures

Guiot, H. F. L.; Helmig-Schurter, A. V.; Meer, J.W.M. van der; Furth, R. van

doi:10.3109/00365548609032322

Cited by 26 publications

(13 citation statements)

References 9 publications

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“…In larger series with neutropenic cancer patients, they represented not more than 10% of all bacteremic infections, and were responsible for less than 5% of documented infections [4,5,15,16,42]. The rate of streptococcal septicemia during previous conventional chemotherapy-associated neutropenic febrile episodes in our patients was only 2%, and in more recent smaller series, streptococcal bacteremia in patients with leukemia has been reported at similarly low rates [13,22,23,37,46]. Only few studies cite a substantially elevated rate [6,8,12,26,39,49], but specific risk factors have not been clarified.…”

Section: Discussionmentioning

confidence: 62%

High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia

1987

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Twenty-nine adult patients with acute myelogenous leukemia AML who received 40 treatment courses with high dose cytosine arabinoside (HD-A), alone or combined with other cytotoxic drugs, for remission induction (RI) or postremission intensive consolidation (IC) were retrospectively analysed for types and severity of infectious complications. In this paper, we report the unusually high rate of streptococcal septicemia in our patients. Of 13 bacteremic infections in a total of 45 infectious episodes, 10 were caused by streptococci (9 viridans streptococci, 1 group B hemolytic streptococcus). Three of them were lethal. After reviewing all documented cases of streptococcal septicemia in the same study period, four additional cases among adult patients with AML were identified. Three of them have had antileukemic chemotherapy without HD-A, while one have had HD-A as a conditioning regimen for bone marrow transplantation. Only three cases were documented to occur in adult patients with AML. Patients treated with HD-A for RI or IC had a significantly lower risk of streptococcal septicemia during previous chemotherapy-associated febrile neutropenic episodes (1/55 vs 10/45; P = 0.01). Neither prophylactic regimens including trimethoprim-sulfamethoxazole nor those without it were effective in preventing streptococcal septicemia. Further studies are needed to confirm these data before the value of additional or alternative prophylactic antibiotics is proven necessary.

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Section: Discussionmentioning

confidence: 62%

High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia

1987

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“…All patients became granulocytopenic (< 100/mm 3) for at least 2 weeks following their cytotoxic treatment. Infection prevention consisted of selective decontamination (oral regimen: neomycin, polymyxin B, pipemidic acid, amphotericin B) in combination with local antiseptic treatment of the oral cavity, protective isolation, and well-cooked food [4,5]. In addition, most patients were given penicillin G prophylaxis for streptococcal infection [6].…”

Section: Methodsmentioning

confidence: 99%

The relevance of cultures of catheter-drawn blood and heparin-lock fluid to diagnose infection in hematologic patients

1992

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The results of bacteriologic cultures of blood and heparin-lock fluid, both drawn from the central venous catheters of 54 consecutive oncohematologic patients, have been used to determine their value for the diagnosis of systemic and catheter-associated infection. In 30 patients with clinical signs of infection (bacteremia or septicemia), 74 of 1000 (7.4%) heparin-lock fluid cultures, 114 of 542 (21%) catheter-drawn blood cultures, and 36 of 134 (26%) venipuncture blood cultures became positive, whereas in 24 patients without clinical signs of infection the respective values were 5 of 700 (0.7%), one of 220 (0.4%), and none of ten cultures. Comparison of the results of cultures sampled on the same day reveals that the positive and negative predictive values for catheter-drawn blood cultures, with the venipuncture blood cultures taken as the standard for bacteremia, are 82% and 95% respectively. The results of heparin-lock fluid are indicative for clinically relevant colonization of the catheter. Three or more positive heparin-lock fluid cultures, sampled on subsequent days, were correlated with the occurrence of bacteremia or septicemia with a positive predictive value of 100%. The conclusions are supported by the results of scanning electron microscopy.

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“…An example of the last is prophylactic acyclovir, which has proved useful in patients undergoing bone marrow transplantation as it can eliminate the reactivation of herpes simplex virus [25]. It was pointed out by Schimpff [26] that in some studies the presence or absence of colonization correlated with subsequent infection and a low granulocyte count in patients undergoing selective microbial suppression [11]. Therefore, this approach was helpful in establishing the value of antimicrobial prophylaxis.…”

Section: Evaluation Of Effectiveness Of Other Preventive Measuresmentioning

confidence: 99%

The role of surveillance cultures in patients likely to develop chemotherapy-induced mucositis

Feld

1997

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Mucositis can be the major dose-limiting toxicity during the adminstration of certain types of chemotherapy, especially 5-fluorouracil, methotrexate and doxorubicin. Infection probably plays a role after initial inflammatory changes occurs in the mucous membranes of the mouth after chemotherapy, especially if the patient becomes neutropenic. The issues addressed in this paper following a review of the literature are whether surveillance cultures can be helpful to avoid mucositis or at least predict who will be at risk for its development and whether this will be a help in decisions on the antimicrobial treatment that should be given if mucositis develops. Bacterial, fungal and viral causes of mucositis have been identified. The simplest to deal with is viral, since if herpes simplex is identified it should be treated with acyclovir; in the case of allogeneic bone marrow transplants acyclovir is usually given prophylactically. Fungal organisms almost certainly play a part; especially if a Candida species, particularly Candida tropicalis, is identified in surveillance cultures, it is probably important. The significance of bacterial pathogens in surveillance cultures is more difficult to sort out except for Pseudomonas aeruginosa, which almost always predicts for eventual systemic infection, especially bacteraemia. The poor overall predictive value (both positive and negative) for surveillance cultures and their significant expense do not support their routine use in 1997.

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Selective Antimicrobial Modulation of the Intestinal Microbial Flora for Infection Prevention in Patients with Hematologic Malignancies: Evaluation of Clinical Efficacy and the Value of Surveillance Cultures

Cited by 26 publications

References 9 publications

High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia

High risk of streptococcal septicemia after high dose cytosine arabinoside treatment for acute myelogenous leukemia

The relevance of cultures of catheter-drawn blood and heparin-lock fluid to diagnose infection in hematologic patients

The role of surveillance cultures in patients likely to develop chemotherapy-induced mucositis

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