Günther I, Kaben U, Dunker H, Brijmohan-Günther R, Konrad H
Clinic of Internal Medicine, Wilhelm Pieck University, Rostock, GDR.
Tokai J Exp Clin Med. 1986;11 Suppl:15-22.
Selective decontamination (SD) is used for prevention of bacterial as well as fungal infection in acute leukemia patients during remission induction therapy. We analyzed 138 treatment periods of 108 patients. The intensified chemotherapy resulted in severe granulocytopenia below 0.1 X 10(9) l for over 25.2 days. In 19 patients there was a suspect of major fungal infection, for which they were given antimycotics (in 15 cases amphotericin B and 5-fluocytosin). Fourteen of them died. Major fungal infections were documented in 5 cases. In 18% of the deceased we found major fungal infection (7 cases of Candida sp., 5 cases of Aspergillus, one case of Candida as well as mucor). There was a correlation between fungal infection, the late stages of the haematological malignancy and the lesions appearing on the oropharyngeal mucosa. However, no correlation appeared to exist in the serological and culture findings between the groups with and without fungal infection. The SD-regime is meant to suppress the Candida cell concentration in the digestive tract but has no influence on Aspergillus in the respiratory tract. The clinical occurrence of major fungal infections published in the E.O.R.T.C.--Gnotobiotic Project Group was 8.2%. According to the literature there is in the eighties a tendency for an increased incidence of aspergillosis. The use of the SD-regime as prophylaxis as well as early antifungal therapy appear to be of great advantage in reducing the frequency of fungal infections in immunocompromised patients.
选择性消化道去污（SD）用于预防急性白血病患者缓解诱导治疗期间的细菌和真菌感染。我们分析了108例患者的138个治疗周期。强化化疗导致严重粒细胞减少，低于0.1×10⁹/L持续超过25.2天。19例患者疑似发生严重真菌感染，为此给予了抗真菌药物（15例使用两性霉素B和5-氟胞嘧啶）。其中14例死亡。5例确诊为严重真菌感染。在18%的死亡患者中发现严重真菌感染（7例念珠菌属、5例曲霉菌、1例念珠菌以及毛霉菌）。真菌感染、血液系统恶性肿瘤晚期与口咽黏膜病变之间存在相关性。然而，真菌感染组和非真菌感染组在血清学和培养结果方面似乎不存在相关性。SD方案旨在抑制消化道中的念珠菌细胞浓度，但对呼吸道中的曲霉菌无影响。欧洲癌症研究与治疗组织——无菌动物项目组公布的严重真菌感染临床发生率为8.2%。根据文献，在20世纪80年代曲霉菌病的发病率有上升趋势。使用SD方案进行预防以及早期抗真菌治疗在降低免疫功能低下患者真菌感染频率方面似乎具有很大优势。
