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Use of oral antibiotics in protected units environment: clinical effectiveness and role in the emergence of antibiotic resistant strains

par Klastersky, Jean ;Debusscher, Louise ;Weerts, Danièle;Daneau, Didier
Référence PATH.BIOL., 22, 1, page (5-12)
Publication Publié, 1974

Article révisé par les pairs

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Résumé :

The preliminary results of a trial studying the effect on the frequency of infections in patients with acute leukemia are presented. The authors compared a plastic isolator + nonabsorbable antibiotics; nonabsorbable antibiotics and ward care. Medical supervision and care was ensured by the same medical and nursing team in a specially designed unit. A total of 43 courses of therapy were studied. The incidence of bacteriologically proven infections was significantly reduced in patients belonging to groups 1 and 2 as compared to the controls (p< 0.02). No advantage of the use of isolation in addition to gastrointestinal decontamination alone could be detected. The isolation procedure did not reduce the frequency with which bacteria were isolated from the patients, suggesting that the persistent strains originate from the fecal flora rather than from the environment. The bacteria isolated from decontaminated patients were considerably more resistant to neomycin, kanamycin and polymyxin B than those isolated from the controls. Strains of Gram negative bacilli that were found repeatedly in the decontaminated patients were often responsible subsequently for severe infections. Some of these strains persisted within the fecal flora in spite of the use of antibiotics to which the colonizing organisms were fully sensitive.