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Infections Post Transplant

Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Bone Marrow Transplantation volume 26, pages 993–997 (2000)Cite this article

Abstract

Invasive fungal infections (IFI) are increasingly diagnosed in patients undergoing allogeneic BMT. We have previously shown that the addition of metronidazole to ciprofloxacin for gastrointestinal bacterial decontamination significantly reduces the incidence of grades II–IV aGVHD by reduction of the anaerobic intestinal bacterial flora. Here, we found that the combined use of ciprofloxacin, metronidazole and fluconazole as antifungal prophylaxis increased intestinal yeast colonization when compared to ciprofloxacin and fluconazole alone (P < 0.01). Based on the EORTC criteria, a total of 18 out of 134 study patients developed IFI: seven of 68 (10%) patients who received metronidazole compared to 11 of the 66 (17%) patients decontaminated without metronidazole developed IFI (log-rank P = 0.36). Lethal IFI occurred in two of seven patients receiving metronidazole and in four of 11 patients without anaerobic decontamination. In conclusion, bacterial intestinal decontamination using metronidazole as an antibiotic with activity against most anaerobic intestinal bacteria significantly increases the intestinal yeast burden without influencing the incidence of IFI in patients undergoing allogeneic BMT. Bone Marrow Transplantation (2000) 26, 993–997.

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References

  1. Wingard JR . Advances in the management of infectious complications after bone marrow transplantation Bone Marrow Transplant 1990 6: 371–383

    CAS  PubMed  Google Scholar 

  2. Krüger WH, Kroger N, Russmann B et al. Treatment of mycotic infections after haemopoietic progenitor cell transplantation with liposomal amphotericin-B Bone Marrow Transplant 1998 22: (Suppl. 4) 10–13

    Google Scholar 

  3. Storb R, Deeg HJ, Whitehead J et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease after bone marrow transplantation for leukemia New Engl J Med 1986 314: 729–735

    Article  CAS  Google Scholar 

  4. Storb R, Deeg HJ, Pepe M et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease in patients given HLA-identical marrow grafts for leukemia: long-term follow-up of a controlled trial Blood 1989 73: 1729–1734

    CAS  PubMed  Google Scholar 

  5. Atkinson K, Farrell C, Chapman G et al. Female marrow donors increase the risk of acute graft versus host disease: effect of donor age and parity and analysis of cell subpopulation in the donor inocculum Br J Haematol 1986 63: 231–239

    Article  CAS  Google Scholar 

  6. Van Bekkum DW, Roodenburg J, Heidt PJ et al. Mitigation of secondary disease of allogeneic mouse radiation chimeras by modification of the intestinal microflora J Nat Cancer Inst 1974 52: 401–404

    Article  CAS  Google Scholar 

  7. Van Bekkum DW, Knaan S . Role of bacterial microflora in development of intestinal lesions from graft-versus-host reaction J Nat Cancer Inst 1977 58: 787–790

    Article  CAS  Google Scholar 

  8. Gale RP, Bortin MM, van Bekkum DW et al. Risk factors for acute graft versus host disease Br J Haematol 1987 67: 397–406

    Article  CAS  Google Scholar 

  9. Beelen DW, Elmaagacli A, Müller KD et al. Influence of intestinal bacterial decontamination using metronidazole and ciprofloxacin or ciprofloxacin alone on the development of acute graft-versus-host disease after marrow transplantation in patients with hematologic malignancies: final results and long-term follow-up of an open-label prospective randomized trial Blood 1999 93: 3267–3275

    CAS  PubMed  Google Scholar 

  10. Samonis G, Gikas A, Anaissie EJ et al. Prospective evaluation of effects of broad spectrum antibiotics on gastrointestinal yeast colonization of humans Antimicrob Agents Chemother 1993 37: 51–53

    Article  CAS  Google Scholar 

  11. Ottinger HD, Albert E, Arnold R et al. German consensus on immunogenetic donor search for transplantation of allogeneic bone marrow and peripheral blood stem cells Bone Marrow Transplant 1997 20: 101–105

    Article  CAS  Google Scholar 

  12. Beelen DW, Haralambie E, Brandt H et al. Evidence that sustained growth suppression of intestinal anaerobic bacteria reduces the risk of acute graft versus host disease after sibling marrow transplantation Blood 1992 80: 2668–2676

    CAS  PubMed  Google Scholar 

  13. Denning DW, Marinus A, Cohen J et al. An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: diagnosis and therapeutic outcome. EORTC invasive fungal infections J Infect 1998 37: 173–180

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Bone Marrow Transplantation, University Hospital Essen, Essen, Germany

    R Trenschel, R Peceny, V Runde, A Elmaagacli, UW Schaefer & DW Beelen

  2. Institute of Microbiology, University Hospital Essen, Essen, Germany

    H Dermoumi, EHeintschel von Heinegg & K-D Müller

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  1. R Trenschel
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  2. R Peceny
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  3. V Runde
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  4. A Elmaagacli
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  5. H Dermoumi
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  6. EHeintschel von Heinegg
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  7. K-D Müller
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  8. UW Schaefer
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  9. DW Beelen
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Trenschel, R., Peceny, R., Runde, V. et al. Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination. Bone Marrow Transplant 26, 993–997 (2000). https://doi.org/10.1038/sj.bmt.1702655

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