Streptococcus mitis sepsis in bone marrow transplant patients receiving oral antimicrobial prophylaxis

Article Abstract:

Patients who receive bone marrow transplants are given immunosuppressive therapy to prevent tissue rejection and are, therefore, vulnerable to opportunistic infections (which do not affect people in good health). Infections are the leading cause of death in these patients, and may include bacterial, viral and fungal infections. Bacterial infections often respond to treatment, especially if white blood cells counts are sufficient. Although treatment programs have been designed for infections by one class of bacteria, the gram-negative class, infections due to gram-positive bacteria may be a serious problem in bone marrow transplant recipients. Infections due to Streptococcus mitis in six bone marrow transplant patients are described. From 1986 to 1988, 6 of 21 bone marrow transplant patients developed bacteremia (infection in the blood) caused by S. mitis. Five patients had fevers, three had low blood pressure, and two developed respiratory failure. Five of six patients developed the bacteremia within 72 hours of transplant; 19 days was the longest span between transplant and infection. After the streptococcal bacteremia, three of the six patients developed another bacterial infection. The patients ranged from 14 to 39 years of age; five were male and one was female. Three had Hodgkin's lymphoma, two had non-Hodgkin's lymphoma, and one had acute lymphoblastic leukemia. All patients were neutropenic (had low white blood cell counts) during bacteremia, which lasted 10 days on average. Four of the patients had mucositis, inflammation of mucous membranes, a risk factor for streptococcal infection. The probability of developing S. mitis bacteremia was significantly related to receiving prophylactic antibiotic therapy with norfloxacin, compared with vancomycin, tobramycin, and polymyxin. Since the bacteria were genetically diverse, a common source of infection was unlikely. The findings suggests that norfloxacin should not be included in the antimicrobial regimen for bone marrow transplant recipients with neutropenia and the potential for mucositis. Further research should evaluate alternative combination antibiotic regimens. (Consumer Summary produced by Reliance Medical Information, Inc.)

Streptococcal infections, Risk factors, Physiological aspects, Immunosuppressive agents, Bacteremia, Norfloxacin

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Low-dose amphotericin B prophylaxis against invasive Aspergillus infections in allogeneic marrow transplantation

Article Abstract:

Patients who receive transplants of new bone marrow, the tissue that produces protective immune cells, are susceptible to several infectious diseases. As the procedure has improved, these threats have decreased, but infection with Aspergillus, a group of fungal organisms, is the most frequent cause of infection-related death in most patients. Patients who have neutropenia (low levels of neutrophils, a type of white blood cell) are especially at risk, as are patients who received transplants due to hematologic (blood cell) diseases. Among the techniques used to minimize these infections have been testing for early detection, filtration of room air, and isolation of patients. However, the effect of these efforts have been slight and the death rate has remained significant. An alternative treatment is prophylactic antifungal therapy, but the efficacy of this approach in preventing infections in transplant patients has not been established. The incidence and outcome of aspergillosis in 186 patients with marrow transplants who were treated with amphotericin B, an antifungal drug, were evaluated. One group of 28 patients were treated in a general ward and received amphotericin only for suspected infections. A second group of 48 patients were treated in laminar airflow (LAF) isolation rooms and received the drug only for suspected infections. The third group of 110 patients were similar to the second group, except they also received amphotericin prophylactically. The results indicated that the third group had a significantly lower rate of aspergillosis, the lowest rate of transplant-related deaths, and a lower rate of death associated with infections with Aspergillus and cytomegalovirus; this group also had significantly less liver dysfunction. These results indicate that amphotericin B, given on a preventive basis, can significantly reduce the rate of illness and death due to aspergillus infections in bone marrow transplant patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Drug therapy, Aspergillosis, Amphotericin B

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Therapeutic antibiotic monitoring: surveillance using a computerized expert system

Article Abstract:

Antibiotic treatment should be started early in the course of an infection in order to successfully eliminate the infection without causing many complications. However, the inappropriate use of antibiotics may result in a weakening or loss of the therapeutic action of the antibiotic, as well as unfavorable side effects, problems with cost, and therapeutic failures. This can be prevented by education, although there is always a need for continual assessment of the nature of the infection. One method of choosing appropriate antibiotics is to continuously monitor the type of bacteria causing the infection. A computerized expert system to improve antibiotic treatment is evaluated. The types of bacteria and the sensitivity of these bacteria to prescribed antibiotics were determined in 2,157 specimens from 1,632 hospitalized patients. Based on these findings, computer programs were used to identify patients with inappropriate antibiotic therapy, and a therapeutic antibiotic monitor (TAM) alert was given to the physician by the clinical pharmacist. Inappropriate antibiotic therapy was identified in 696 instances, 276 cases of which were false alarms. Physicians responded by either changing or starting antibiotic therapy in 125 of 420 alerts. The results show that computer-assisted monitoring serves as an effective method of identifying and correcting errors in antibiotic therapy, thereby improving the use of antibiotics.

Usage, Evaluation, Antibiotics, Expert systems, Drug utilization, Drug monitoring

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