Infection prevention in granulocytopenic patients by selective decontamination of the digestive tract

Abstract

In a controlled prospective randomized trial we studied the effect of selective decontamination of the digestive tract (SDD) in granulocytopenic patients on the frequency of infections. By SDD it was aimed to suppress the pathogenic Gramnegative micro-organisms and yeasts without affecting the non-pathogenic anaerobic flora. This anaerobic flora was maintained intact because of its value for the colonization resistance of the gastrointestinal tract. SDD was accomplished by oral administration of nalidixic acid or co-trimoxazole or polymyxin E to suppress growth of aerobic Gram-negative bacteria, and amphotericin-B to inhibit growth of yeasts. Gram-negative or yeast infections occurred in the control group 18 times in 12 patients; in the decontaminated group two times in two patients (P < 0.01). Clinical infections occurred 15 times in 12 control patients and four times in three SDD treated patients (0.01 < P < 0.05). While nine patients in the control group died with an acquired infection none died in the SDD treated group (P < 0.01). It is concluded that SDD is a promising and widely applicable method of infection prevention. It decreases the need for treatment in a 'protected environment'. © 1980.