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Vergleichende Studie zum Wert der selektiven Darmdekontamination (SDD) bei der Behandlung akuter Leukämien

Comparative study on the value of selective decontamination of the digestive tract in acute leukemia patients

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Summary

A comparative study of infectious morbidity and mortality in neutropenic patients with acute leukemia receiving chemotherapy was undertaken to test the effects of a suppression of endogenous and ambient microorganisms. Patients were allocated to receive [1] oral antibiotics (neomycin, colistin, and nystatin) in conventional ward isolation; [2] no antimicrobial suppression but conventional ward isolation; [3] strict isolation, filtered air, sterilized food and oral antibiotics. Significantly fewer infections with Gram-negative bacilli were seen in patients with strict isolation plus endogenous microbial suppression versus patients receiving selective gut decontamination versus patients without nonabsorbable antibiotics in simple reverse isolation. The death rate from infection was significantly reduced in patients who received antibiotics for gut flora suppression in conventional ward isolation compared with the corresponding control group. In addition, a significant improvement of leukemic remission rate was seen in this group. The protocol for decontamination was well tolerated.

Zusammenfassung

Im Hinblick auf eine Senkung der Frühtodesrate durch Infektionen wurde in einer vergleichenden Studie der Wert einer selektiven Darmdekontamination (SDD) bei der zytostatischen Behandlung von Patienten mit akuter Leukämie untersucht. Es wurden drei Gruppen gebildet: 1) SDD (Neomycin, Colistin, Nystatin) bei einfacher Umkehrisolation auf der Normalstation; 2) keine SDD, aber einfache Umkehrisolation auf der Normalstation; 3) strikte Isolation, gefilterte Luft, sterilisierte Nahrung plus SDD. Es fanden sich graduell zwischen den drei Gruppen signifikant weniger Infektionen mit Gramnegativen Keimen: Isolierstation plus SDD versus Normalstation plus SDD versus Normalstation ohne SDD. Die Frühtodesrate durch Infektionen war in der Gruppe mit SDD auf der Normalstation signifikant geringer als in der Gruppe ohne SDD, umgekehrt die Remissionsrate nach zytostatischer Behandlung signifikant höher. Die Dekontamination wurde gut vertragen.

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Authors and Affiliations

  1. Medizinische Klinik III-Großhadern, Universität München, Germany

    U. Jehn, Ch. Clemm &  Wilmanns

  2. Max-v.-Pettenkofer-Institut für Hygiene und Medizinische Mikrobiologie, Universität München, Germany

    G. Ruckdeschel

  3. Abtlg. Klinische Hämatologie, GSF-Institut für Hämatologie, München

    H. Sauer

Authors
  1. U. Jehn
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  2. G. Ruckdeschel
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  3. H. Sauer
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  4. Ch. Clemm
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  5. Wilmanns
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Jehn, U., Ruckdeschel, G., Sauer, H. et al. Vergleichende Studie zum Wert der selektiven Darmdekontamination (SDD) bei der Behandlung akuter Leukämien. Klin Wochenschr 59, 1093–1099 (1981). https://doi.org/10.1007/BF01746196

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  • DOI: https://doi.org/10.1007/BF01746196

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