de Jong P J, de Jong M D, Kuijper E J, van der Lelie H
Department of Hematology, University of Amsterdam, The Netherlands.
Scand J Infect Dis. 1993;25(1):107-13.
230 neutropenic episodes in 84 patients with acute myeloid leukemia receiving selective intestinal decontamination were studied to evaluate the ability of surveillance cultures to monitor the efficacy of microbial suppression, to identify causative organisms in case of fever, and to predict infection due to potential pathogens (i.e. Staphylococcus aureus and aerobic Gram-negative bacteria). Most cultures became negative soon after the administration of prophylactic antibiotics and there were only few persistent colonizations. 14 potential pathogens resistant to the intestinal decontamination regimen were isolated in surveillance cultures, none of which caused infection. Of the 212 febrile episodes, only 22 were caused by a microbiologically documented infection with potential pathogens. Most microbiologically documented infections were caused by organisms not routinely identified by surveillance cultures, indicating efficient selective intestinal decontamination. Only 9 (41%) of the 22 infections with potential pathogens were predicted by surveillance cultures. We conclude that surveillance cultures are of limited use in predicting infection or identifying causative organisms of fever in neutropenic patients receiving selective intestinal decontamination. However, they are useful in monitoring the efficacy of microbial suppression. One set of surveillance cultures each week after the disappearance of potential pathogens would be sufficient.
对84例接受选择性肠道去污的急性髓系白血病患者的230次中性粒细胞减少发作进行了研究，以评估监测培养物监测微生物抑制效果、在发热时鉴定病原体以及预测潜在病原体（即金黄色葡萄球菌和好氧革兰氏阴性菌）感染的能力。大多数培养物在给予预防性抗生素后不久转为阴性，仅有少数持续定植。在监测培养物中分离出14株对肠道去污方案耐药的潜在病原体，均未引起感染。在212次发热发作中，只有22次是由微生物学证实的潜在病原体感染引起的。大多数微生物学证实的感染是由监测培养物未常规鉴定的微生物引起的，表明选择性肠道去污有效。在22次潜在病原体感染中，监测培养物仅预测到9次（41%）。我们得出结论，监测培养物在预测接受选择性肠道去污的中性粒细胞减少患者的感染或鉴定发热病原体方面作用有限。然而，它们在监测微生物抑制效果方面是有用的。在潜在病原体消失后每周进行一组监测培养就足够了。
