Summary
During 59 periods of hospitalisation, 39 patients with either acute myeloid leukemia (22), acute lymphatic leukemia (9), acute undifferentiated leukemia (1), blastic crisis of chronic myeloid leukemia (6) or high-grade malignant non-Hodgkin lymphoma (1) were subjected to aggressive polychemotherapy after selective decontamination of the gut. The patients were given an amphotericin B suspension in a dosage of 1.2 g/day for two days, after which one tablet of trimethoprim/sulphamethoxazole (TMP/SMZ) (160 mg TMP and 800 mg SMZ) t.i.d. was added to prevent endogenous infections by gram-negative aerobic bacteria or moulds and to maintain the “colonisation resistance” endowed by the anaerobes. During 16 of the 59 periods of hospitalisation, no potentially pathogenic aerobic bacteria were isolated, TMP/SMZ-resistantEscherichia coli were the etiological agent of septicemia in two patients, and resistantKlebsiella pneumoniae andPseudomonas aeruginosa in two other patients. These bacteria were cultured from the patients fecal samples prior to the development of septicemia. We observed that long-term prophylaxis with TMP/SMZ modified the normal aspect of the fecal biotop culture, not only by suppressing the aerobic gram-negative bacteria, but also by allowing certain clostridia to appear. We differentiated 207 clostridia from the fecal samples of 29 patients and observed a predominance of TMP/SMZ-resistantClostridium difficile, Clostridium innocuum andClostridium clostridiiforme. C. difficile was also isolated from the blood culture of a neutropenic patient treated with TMP/SMZ and proved to be very toxic in the Verocell culture.
Zusammenfassung
Während 59 Krankenhausaufenthalten wurden 39 Patienten nach selektiver Dekontamination des Darmes einer aggressiven Polychemotherapie unterzogen. 22 Patienten litten an akuter myeloischer und neun an akuter lymphatischer Leukämie, ein Patient an akuter undifferenzierter Leukämie, sechs Patienten befanden sich in der Blastenkrise einer chronischen myeloischen Leukämie und einer litt an Non-Hodgkin-Lymphom von hohem Malignitätsgrad. Die Patienten erhielten Amphotericin B Suspension 1,2 g/die, nach 2 Tagen zusätzlich Trimethoprim/Sulphamethoxazol (TMP/SMZ) 3×1 Tabl./die (160 mg TMP und 800 mg SMZ), um endogene Infektionen durch gramnegative Aerobier und Pilze zu verhüten und um gleichzeitig die „colonisation resistance“, die durch Anaerobier gegeben ist, zu erhalten. Während 16 von 59 Krankenhausaufenthalten konnten keine potentiell pathogenen aeroben Bakterien isoliert werden. TMP/SMZ-resistenteEscherichia coli verursachten eine Sepsis bei zwei Patienten, resistenteKlebsiella pneumoniae undPseudomonas aeruginosa bei zwei anderen. Diese Keime wurden aus den Stuhlproben der Patienten gezüchtet, schon bevor sich die Sepsis entwickelte. Wir beobachteten, daß die Langzeit-Prophylaxe mit TMP/SMZ die fäkale Biotop-Kultur nicht nur durch das Fehlen der aeroben gramnegativen Darmbakterien veränderte, sondern auch durch das Aufkommen bestimmter Clostridien. Wir differenzierten 207 Clostridien in Stuhlproben von 29 dieser Patienten und beobachteten das gehäufte Vorkommen von Trimethoprim/Sulphamethoxazol-resistentenClostridium difficile, Clostridium innocuum undClostridium clostridiiforme. C. difficile wurde auch aus der Blutkultur einer TMP/SMZ-behandelten Patientin isoliert und erwies sich in der Verozell-Kultur als sehr toxisch.
Similar content being viewed by others
Literature
Brittinger, G., Scholz, N., Linzenmeier, G., Wendt, F. Infektiöse Komplikationen bei Erkrankungen der Granulopoese. Wien. Klin. Wochenschr. 85 (1973) 341–350.
European Organisation for Research on Treatment of Cancer: E. O. R. T, C. Gnotobiotic Project Group Writing committee:Dietrich, M., Gaus, W., Vossen, J., Waaij, D. van der, Wendt, F.: Isolation and antimicrobial decontamination in patients with high susceptibility to infection. Infection 5 (1977) 107–114.
Hahn, D. M., Schimpf, S. C., Fortner, C. L., Collier-Smith, A., McYoung, V., Wiernik, P. H. Infection in acute leukemia patients receiving oral nonabsorbable antibiotics. Antimicrob. Agents Chemother. 13 (1978) 958–964.
Hargadon, M. T., Young, M. V., Schimmpf, S. H., Wade, J. C., Minah, G. E. Selective suppression of alimentary tract microbial flora as prophylaxis during granulocytopenia. Antimicrob. Agents Chemother. 20 (1981) 620–624.
Vries-Hospers, H. G. de Selective decontamination of the digestive tract. Profefschrift, Drukkerij van Denderen B. V., Groningen 1981, pp. 22–30.
Waaij, D. van der The colonisation resistance of the digestive tract in man and animals. Proceedings International Symposium Experimental and Clinical Gnotobiotics, Ulm 1978. Zentralbl. Bakteriol. Suppl. 7 (1979) 155.
Linzenmeier, G., Haralambie, E. Chemoprophylaxe vor Operationen am Darm. Aussagemöglichkeiten bei der quantitativen Untersuchung der Stuhlflora auf Bakterien und Pilze. Zentralbl. Bakteriol. Hyg. I. Abt. Orig. A. 243 (1979) 326–335.
Haralambie, E., Linzenmeier, G. Various Clostridia of the human gut.Sasaki, S. (ed.): Recent advances in germfree research. Proceedings VII. International Symposium on Gnotobiology. Tokio University Press, Tokio 1981, pp. 207–211.
Holdemann, L., Moore, W. E. Anaerobe laboratory manual. 4th edition. Virginia Polytechnic Institute and State University, Blacksburg 1977, pp. 67–68.
Goddard, P., Fernandez, F., West, B., Hill, M. J., Barnes, P. Dehydrogenation of steroids by intestinal bacteria. J. Med. Microbiol. 8 (1975) 429–435.
Finegold, S. M. Anaerobic bacteria in human disease. Academic Press, New York, San Francisco, London 1977, pp. 69–72.
Möse, J. R., Moser, M., Fischer, G. Reduzierung der Histaminwirkung durch onkolytisch und nicht onkolytisch wirksame Clostridien. Zentralbl. Bakteriol. Hyg. I. Abt. Orig. 246 (1980) 541–549.
Schau, H. P., Fabricius, E.-M., Schneeweiss, U., Bendrix, A. Untersuchung zur Charakterisierung eines Clostridienstammes zur Krebstherapie. Zentralbl. Bakteriol. Hyg. Abt. I. Orig. A 264 (1989) 80–97.
Raibaud, P., Ducluzeau, R., Dubos, F., Saquet, E. Spore formation and germination ofClostridium perfringens in the digestive tract of holoxenic and axenic mice. J. Appl. Bacteriol. 35 (1972) 177–184.
Gibbs, P. A. The activation of spores ofClostridium bifermentans. J. Gen. Microbiol. 46 (1967) 285–291.
Bartlett, J. G., Chang, Te Wen, Gurwith, M., Gorbach S., Overdonk, A. Antibiotic-associated pseudomembranous colitis due to toxin-producing Clostridia. N. Engl. J. Med. 298 (1978) 531–543.
Boriello, S. P., Larson, H. E. Antibiotic and pseudomembranous colitis. J. Antimicrob. Chemother. 7 Suppl. A (1981) 53–62.
Larson, H. P., Price, A. B. Pseudomembranous colitis; Presence of clostridial toxin. Lancet II (1977) 1312–1314.
Rial, D. R., Helebean, S., Finegold, S. M. Bacterial interference betweenClostridium difficile and normal fecal flora. J. Infect. Dis. 143 (1981) 470–475.
Brophy, P., Knoop, F. C. Bacillus pumilus in the induction of clindamycin-associated enterocolitis in guinea pigs. Infect. Immun. 35 (1982) 289–295.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Haralambie, E., Mahmoud, H.K., Linzenmeier, G. et al. The “Clostridial effect” of selective decontamination of the human gut with trimethoprim/sulphamethoxazole in neutropenic patients. Infection 11, 201–204 (1983). https://doi.org/10.1007/BF01641197
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01641197