Summary
In a previous study we demonstrated that trimethoprim-sulfamethoxazole decreases the prevalence of infection in patients with severe granulocytopenia. However, treatment was accompanied by a relatively high incidence of multiresistant microorganisms. We therefore conducted this study to determine whether the addition of colistin to the trimethoprimsulfamethoxazole regimen prevents the emergence of these resistant bacteria. Thirty consecutive adult patients with acute non-lymphocytic leukaemia received trimethoprim-sulfamethoxazole plus colistin p.o. prophylactically. The results of this study were compared with the results of our previously published controlled study. Trimethoprim-sulfamethoxazole plus colistin was as effective as trimethoprim-sulfamethoxazole in preventing infection. However, the addition of colistin significantly reduced the acquisition of and infection by gram-negative bacilli which were resistant to trimethoprim-sulfamethoxazole. Only two patients were colonized with resistant strains, and no infections with these strains were observed. We have concluded that patients with acute non-lymphocytic leukaemia should receive a combination of trimethoprim-sulfamethoxazole plus colistin prophylactically during remission induction treatment.
Zusammenfassung
Nach Ergebnissen früherer Untersuchungen vermindert Trimethoprim-Sulfamethoxazol bei Patienten mit schwerer Granulozytopenie die Infektionsinzidenz. Doch kommt es dabei relativ häufig zum Auftreten multiresistenter Mikroorganismen. In der vorliegenden Studie wird geprüft, ob der Zusatz von Colistin zu dem Trimethoprim-Sulfamethoxazol-Behandlungsschema das Auftreten dieser resistenten Bakterien verhindern kann. 30 nacheinander behandelte Patienten mit akuter, nicht-lymphatischer Leukämie erhielten eine Prophylaxe mit Trimethoprim-Sulfamethoxazol plus Colistin per os. Die Ergebnisse wurden mit unserer früher publizierten, kontrollierten Studie verglichen. In bezug auf Infektionsverhütung waren Trimethoprim-Sulfamethoxazol plus Colistin und Trimethoprim-Sulfamethoxazol allein gleichwertig. Die Zugabe von Colistin verminderte jedoch außerdem signifikant die Zahl der Infektionen mit gramnegativen, gegenüber Trimethoprim-Sulfamethoxazol resistenten Bakterien. Nur zwei Patienten waren mit resistenten Stämmen besiedelt, die jedoch keine Infektionen verursachten. Wir schließen daraus, daß Patienten mit akuter, nicht-lymphatischer Leukämie während der Behandlung zur Induktion einer Remission die Kombination Trimethoprim-Sulfamethoxazol plus Colistin zur Infektionsprophylaxe erhalten sollten.
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Rozenberg-Arska, M., Dekker, A.W. & Verhoef, J. Colistin and trimethoprim-sulfamethoxazole for the prevention of infection in patients with acute non-lymphocytic leukaemia. Decrease in the emergence of resistant bacteria. Infection 11, 167–169 (1983). https://doi.org/10.1007/BF01641298
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DOI: https://doi.org/10.1007/BF01641298