A controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients
A controlled study of isolation and endogenous microbial suppression in acute myelocytic leukemia patients
复制标题
急性髓细胞白血病患者分离和内源性微生物抑制的对照研究
作者：
J. Yates;J. Holland
对接受化疗的急性髓细胞白血病患者的感染发病率进行了一项前瞻性研究，以测试环境和/或内源性微生物减少的效果。患者被随机分配到：(1)既不接受屏障隔离也不接受抗菌抑制；(2)常规病房反向隔离中的抗菌抑制(庆大霉素、万古霉素和制霉菌素)；(3)屏障隔离和过滤空气；(4)屏障隔离、过滤空气和抗菌抑制。随机分组时感染的存在是导致死亡率增加的一个重要因素(p<；0.02)。居住在隔离器中的最初未受感染的人在23个研究天后显示获得严重感染的人数减少，并且在整个研究期间呼吸道感染较少。隔离患者的假单胞菌感染减少。在接受内源性抗菌药物抑制的患者中，感染致死人数较少，但出血致死人数较多。未接受肠道菌群抑制抗生素治疗的孤立患者的缓解率增加(无统计学意义)。这些环境操作并未发现白血病缓解率或存活率的显著改善。
A prospective study of infectious morbidity in patients with acute myelocytic leukemia receiving chemotherapy was undertaken to test the effects of a reduction of ambient and/or endogenous microorganisms. Patients were randomly allocated to receive: (1) neither barrier isolation nor antimicrobial suppression; (2) antimicrobial suppression (gentamicin, vancomycin, and nystatin) in conventional ward reverse isolation; (3) barrier isolation and filtered air; or (4) barrier isolation, filtered air, and antimicrobial suppression. The presence of infection at the time of randomization was a significant factor (p < 0.02) accounting for an increased death rate. Individuals housed in the isolator who were initially uninfected demonstrated a decrease in the acquisition of severe infections after 23 study days, and fewer respiratory infections throughout the study period. Pseudomonas infections were decreased in isolator patients. Fewer fatalities from infection, but more from hemorrhage, were noted in patients who received endogenous antimicrobial suppression. An increased remission rate was seen in isolated patients not receiving antibiotics for gut flora suppression (not statistically significant). Significant improvement of leukemic remission rate or survival by these environmental manipulations was not found.