Summary
Three hundred and forty-two patients with hematological malignancies underwent allogeneic marrow transplantation from family donors and were allocated to receive 1) no specific infection prophylaxis in a conventional hospital room (control, 100 patients), 2) prophylactic systemic antibiotics (PSA) in a conventional hospital room (PSA group, 101 patients), 3) decontamination and isolation in a laminar air flow (LAF) room (LAF group, 65 patients) and 4) PSA in an LAF room (LAF+PSA group, 76 patients). Patients were studied for bacterial and fungal complications from the day of admission and until engraftment. LAF isolation was discontinued before engraftment in 27% (LAF+PSA group) to 32% (LAF group) of isolated patients. PSA was not given according to protocol in 26% (LAF+PSA group) to 27% (PSA group) of patients on prophylactic antibiotics. Septicemia occurred in 41%, 22%, 25% and 10% of patients in the control, PSA, LAF and LAF + PSA group, respectively. The incidence of septicemia was significantly less in the LAF + PSA group than in the control and LAF group with the incidence of septicemia significantly higher in the control group than in any of the other three groups. No other risk factors analyzed in proportional hazards regression tests were associated with septicemia acquisition. It is concluded that effective infection prevention modalities significantly reduce infection morbidity in transplant patients. Since most granulocytopenic transplant patients not receiving PSA will receive empiric or therapeutic broad spectrum antibiotics, the use of PSA in or out of LAF isolation is recommended as an effective modality to reduce septicemia acquisition.
Zusammenfassung
Bei 341 Patienten mit malignen hämatologischen Erkrankungen wurde eine allogene Knochenmarkstransplantation von Spendern aus der Familie durchgeführt. Die Patienten wurden den folgenden Studienarmen zugeordnet: 1) Keine spezifische Infektionsprophylaxe, Pflege in einem konventionellen Krankenzimmer (Kontrollen, 100 Patienten); 2) Systemische Antibiotikaprophylaxe (PSA) in konventionellem Krankenzimmer (101 Patienten); 3) Dekontamination und Isolation in einem Laminar Air Flow(LAF)-Raum (65 Patienten) und 4) PSA in einem LAF-Raum (76 Patienten). Vom Tag der Einweisung bis zur Transplantation wurden die Patienten auf Komplikationen durch bakterielle und Pilzinfektionen untersucht. Vor der Transplantation wurde die LAF-Isolation bei 27% der LAF plus PSA-Gruppe und bei 32% der LAF-Gruppe abgebrochen. Entsprechend Protokoll erhielten 26% der LAF plus PSA und 27% der PSA-Gruppe die Antibiotikaprophylaxe nicht. Septikämien traten bei 41% der Patienten der Kontrollgruppe, 22% der mit PSA in konventioneller Pflegeeinheit, bei 25% der in LAF-Räumen behandelten und bei 10% der in LAF-Räumen gepflegten und zusätzlich mit PSA behandelten Patienten auf. Die Septikämie-Inzidenz war unter LAF mit PSA signifikant geringer als in der Kontrollgruppe und der in LAF-Isolation gepflegten Patientengruppe; zugleich war die Septikämie-Inzidenz in der Kontrollgruppe signifikant höher als in einer der drei anderen Gruppen. Die proportionale Risiko-Regressionsanalyse ergab keine zusätzlichen Risikofaktoren für das Auftreten einer Septikämie. Wirksame Maßnahmen zur Infektionsprophylaxe können folglich die Infektionsmorbidität bei Transplantatempfängern signifikant vermindern. Da die meisten granulozytopenischen Transplantatempfänger eine empirische oder gezielte Therapie mit Breitspektrumantibiotika erhalten, wird die PSA unabhängig von LAF-Isolation als effektive Maßnahme zur Verminderung der Septikämien empfohlen.
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Petersen, F., Thornquist, M., Buckner, C. et al. The effects of infection prevention regimens on early infectious complications in marrow transplant patients: A four arm randomized study. Infection 16, 199–208 (1988). https://doi.org/10.1007/BF01650752
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DOI: https://doi.org/10.1007/BF01650752