骨髓移植感染的预防。

D J Winston, W G Ho, R P Gale, R E Champlin
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引用次数: 0

摘要

由于骨髓移植前的放疗和化疗,骨髓移植前的短暂性粒细胞减少,以及移植后用免疫抑制剂预防和治疗移植物抗宿主病,骨髓移植经历了严重的免疫缺陷。在粒细胞减少期间,口服氟化喹诺酮类药物的化学预防可以预防革兰氏阴性杆菌的定植和感染,比口服不可吸收抗生素或甲氧苄啶-磺胺甲恶唑耐受性更好,比层流隔离或预防性粒细胞输注更具成本效益。然而,口服制霉菌素、酮康唑或两性霉素B的抗真菌预防并不总是有效;经验性静脉两性霉素B治疗仍然是预防致命真菌感染最可靠的方法。骨髓移植后,巨细胞病毒血清阴性患者可通过使用巨细胞病毒血清阴性血液制品和巨细胞病毒免疫球蛋白预防巨细胞病毒感染和间质性肺炎。在巨细胞病毒血清阳性患者中,预防性DHPG(更昔洛韦)目前正在一项对照临床试验中进行评估。单纯疱疹和水痘带状疱疹感染可以通过静脉注射阿昔洛韦有效治疗,但常规的阿昔洛韦预防并不具有成本效益。甲氧苄啶-磺胺甲恶唑用于预防卡氏肺囊虫肺炎,并可继续用于慢性移植物抗宿主病患者,以预防移植后晚期细菌感染。
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Prophylaxis of infection in bone marrow transplants.

Bone marrow transplants experience severe immuno-deficiency as a consequence of pretransplant radiation and chemotherapy, transient granulocytopenia before marrow engraftment, and post-transplant prevention and treatment of graft-versus-host disease with immuno-suppressive agents. During periods of granulocytopenia, chemoprophylaxis with the oral fluorinated quinolones can prevent colonization and infection with gram-negative bacilli, is better tolerated than oral non-absorbable antibiotics or trimethoprim-sulfamethoxazole and is more cost-effective than laminar-air-flow isolation or prophylactic granulocyte transfusions. Antifungal prophylaxis with oral nystatin, ketoconazole or amphotericin B, however, has not been consistently effective; empiric intravenous amphotericin B therapy is still the most reliable way to prevent fatal fungal infections. Following marrow engraftment, cytomegalovirus infection and interstitial pneumonia can be prevented in cytomegalovirus-seronegative patients by the use of cytomegalovirus-seronegative blood products and cytomegalovirus immune globulin. In cytomegalovirus-seropositive patients, prophylactic DHPG (ganciclovir) is currently being evaluated in a controlled clinical trial. Herpes simplex and varicella-zoster infections can be treated effectively with intravenous acyclovir, but routine acyclovir prophylaxis is not cost-effective. Trimethoprim-sulfamethoxazole is used for prophylaxis of Pneumocystis carinii pneumonia and may be continued in patients with chronic graft-versus-host disease for prevention of late post-transplant bacterial infections.

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