| Popis: |
In 135 consecutive patients with acute nonlymphocytic leukemia (ANLL), who were admitted to the Baltimore Cancer Research Program (BCRP) for their first induction chemotherapy shortly after initial diagnosis and who had received no recent antibiotic therapy, surveillance cultures were obtained of specimens from the nose, gingiva, axillas and rectum twice during the first week of hospitalization and then twice weekly thereafter. All organisms which were morphologically distinct on routine culture media were fully identified, and Pseudomonas aeruginosa was serotyped. Baseline surveillance cultures indicated that there was a higher than expected incidence of colonization with gram-negative bacilli in the nose, gingiva and axillas along with the expected colonization by gram-negative bacilli in the rectum. Among these colonizing gram-negative bacilli, Ps. aeruginosa and, to a lesser extent, Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis were most likely to be associated with a subsequent bacteremia during periods of mucosal damage and granulocytopenia. Follow-up surveillance cultures indicated that new organisms were acquired at a rate of 0.5 organism per patient per week with many of these acquired organisms being gram-negative bacilli of the type likely to cause infection in these patients. Compared to similar surveillance cultures obtained in a previous group of patients not subjected to vigorous infection prevention techniques, the rate of new organism acquisition was less and the development of infection subsequent to colonization was reduced. Surveillance cultures also indicated those patients at highest risk of having yeast infections such as those caused by Torulopsis glabrata or Candida species. Results of nasal surveillance cultures detected a subpopulation of patients at greatest risk for colonization and subsequent infection with Aspergillus flavus. Surveillance cultures have been utilized for the design of systemic therapeutic antibiotic protocols and for the monitoring of oral nonabsorbable antimicrobial regimens for alimentary canal microbial suppression. Despite the usefulness of surveillance cultures for research in the epidemiology, prevention and treatment of infection in patients with acute leukemia, their routine use in a nonresearch setting would not be advised. |
