The effects of infection prevention regimens on early infectious complications in marrow transplant patients: a four arm randomized study.

Three hundred and forty-two patients with hematological malignancies underwent allogeneic marrow transplantation from family donors and were allocated to receive 1) no specific infection prophylaxis in a conventional hospital room (control, 100 patients), 2) prophylactic systemic antibiotics (PSA) in a conventional hospital room (PSA group, 101 patients), 3) decontamination and isolation in a laminar air flow (LAF) room (LAF group, 65 patients) and 4) PSA in an LAF room (LAF+PSA group, 76 patients). Patients were studied for bacterial and fungal complications from the day of admission and until engraftment. LAF isolation was discontinued before engraftment in 27% (LAF+PSA group) to 32% (LAF group) of isolated in 26% (LAF+PSA group) to 27% (PSA group) of patients on prophylactic antibiotics. Septicemia occurred in 41%, 22%, 25% and 10% of patients in the control, PSA, LAF and LAF+PSA group, respectively. The incidence of septicemia was significantly less in the LAF+PSA group than in the control and LAF group with the incidence of septicemia significantly higher in the control group than in any of the other three groups. No other risk factors analyzed in proportional hazards regression tests were associated with septicemia acquisition. It is concluded that effective infection prevention modalities significantly reduce infection morbidity in transplant patients. Since most granulocytopenic transplant patients not receiving PSA will receive empiric or therapeutic broad spectrum antibiotics. The use of PSA in or out of LAF isolation is recommended as an effective modality to reduce septicemia acquisition.