Reduction in mortality from gram‐negative sepsis in neutropenic patients receiving trimethoprim/sulfamethoxazole therapy

Abstract

The causes of death were reviewed in 53 patients from two prospective randomized trials on the efficacy of trimethoprim/sulfamethoxazole as prophylaxis of gram‐negative bacillary infection in granulocytopenic patients. Twenty‐nine deaths occurred in patients treated with TMP/SMX prophylaxis while 24 occurred in patients who served as controls in the first trial. The two groups were similar, with the exception that more patients in the TMP/SMX group had acute leukemia (82 versus 50%; P <0.02). Microbiologically documented gram‐negative rod infection preceeded death in 8/24 control patients as compared to 2/29 TMP/SMX recipients (P < 0.02). This decrease in gram‐negative related deaths was most pronounced in the patients with acute leukemia. Fatal gram‐negative rod infection occurred in 7/12 control leukemic patients as compared to 2/24 TMP/SMX treated patients. Despite the reduction in numbers of gram‐negative rod‐related deaths, infectious deaths accounted for 16/24 and 15/29 patients in control and TMP/SMX treated patients, respectively. Similar numbers of fungal, viral, and gram‐positive bacterial infections occurred in each group. Fever with pulmonary infiltrates but without proven etilogic agents were included in the category of “clinically documented infections;” 6/7 patients with fever and undiagnosed pulmonary infiltrates were in the TMP/SMX group. Prophylactic administration or oral trimethoprim/sulfamethoxazole reduces the frequency of fatal gram‐negative rod infections in neutropenic patients. Copyright © 1983 American Cancer Society