Protected Environment — Prophylactic Antibiotic Programmes; Clinical Studies

Evaluation of a protective environment in the management of granulocytopenic patients: a comparative study

Fever, clinical infection, bacteriologically documented infection, and death from infection were evaluated in 95 consecutive uninfected patients with severe granulocytopenia (less than 0.5 x 10(6)/liter). Patients were randomly allocated to reverse isolation and prophylactic oral nonabsorbable antibiotics or to open ward care. The microbiologic surveillance of air samples and stool cultures showed reduction of pathogenic organisms in patients treated in protective environment units. There was a statistically significant reduction in the incidence of fever (80% vs. 39.6%; P less than 0.001), clinical infections (55.3% vs. 25%; P less than 0.01), bacteriologically documented infections (53.2% vs. 20.8%; P less than 0.01), and deaths from infections (25.5% vs. 8.3%; P = 0.02) in patients treated in a protective environment as compared with patients treated on the open ward.

Prophylactic non-absorbable antibiotics in leukaemic patients

A regimen of oral non-absorbable prophylactic antibiotics (kanamycin-vancomycin-nystatin) was given to nine severely neutropaenic leukaemic patients on cytotoxic therapy (11 courses), in conjunction with isolation procedures. An appreciable decrease in faecal organisms, especially anaerobes, was apparent after 48 h of commencing the course, and most bacteria had disappeared from the stool after five days. There were three episodes of septicaemia, all with enteric organisms, whilst on these antibiotics; one proved fatal. The emergence of resistance to aminoglycosides in faecal flora, notably Klebsiella, in 6/11 courses constituted a major problem in the use of such prophylaxis.