粒细胞减少性急性白血病患者使用或不使用预防性诺氟沙星时的全身性感染和定植

J E Karp, J D Dick, W G Merz
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引用次数: 0

摘要

接受强化抗白血病化疗和深度粒细胞减少的患者容易发生压倒性感染,特别是那些由疾病和治疗相关的胃肠道损伤引起的感染。我们之前已经证明,口服诺氟沙星预防(每12小时400毫克)抑制该部位细菌定植的能力会影响需氧革兰氏阴性细菌感染的发生率和分布以及该患者群体感染并发症的总体管理。我们现在已经确定了持续长期口服诺氟沙星对需氧革兰氏阴性细菌感染和定植的广泛影响,骨髓发育不全期间推定和记录的感染的总体管理,以及强化抗白血病化疗期间临床显著的抗生素耐药病原体的出现。在诱导粒细胞减少的整个过程中口服诺氟沙星预防,通过抑制需氧革兰氏阴性感染的发展,特别是那些来自胃肠道的感染,并防止多重耐药病原体的获得或出现,继续提供有效的保护。诺氟沙星对在呼吸道定植的病原体的长期影响也被检测到,并在该部位抑制获得性耐药。由于这些原因,诺氟沙星仍然是这类患者口服预防使用的优良药物。
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Systemic infection and colonization with and without prophylactic norfloxacin use over time in the granulocytopenic, acute leukemia patient.

Patients undergoing intensive antileukemic chemotherapy and profound granulocytopenia are susceptible to overwhelming infections, particularly those arising from disease- and therapy-related gastrointestinal tract damage. We have previously demonstrated that the ability to suppress bacterial colonization of this site with oral norfloxacin prophylaxis (400 mg every 12 h) affects the incidence and distribution of aerobic gram-negative bacterial infections and the overall management of infectious complications in this patient population. We have now determined the broad impact of continuous, long-term use of oral norfloxacin on aerobic gram-negative bacterial infection and colonization, overall management of presumed and documented infections during marrow aplasia and emergence of clinically significant antibiotic resistant pathogens during intensive antileukemic chemotherapy. Oral norfloxacin prophylaxis administered throughout the course of induced granulocytopenia continues to afford effective protection by suppressing the development of aerobic gram-negative infections, particularly those arising from the gastrointestinal tract, and preventing the acquisition or emergence of multiply resistant pathogens. A long-range effect of norfloxacin on pathogens colonizing the respiratory tract is also detected, with inhibition of acquired drug resistance occurring at that site as well. For these reasons, norfloxacin continues to be an excellent agent for oral prophylactic use in this patient population.

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