Tehmina Munir, Munir Lodhi, Tahir Jameel, Tanq Butt.
Efficacy of SDD (selective decontamination of the digestive tract) in reducing the incidence of unexplained fever and infections in early period after Bone Marrow Transplantation.
Pak J Pathol Jan ;13(2):18-23.

Infections remain a leading cause of death in patients of bone marrow transplantation The aim of the study was to determine the incidence of unexplained fever and infections in the early period after BMT in patients who were given therapy for SDD (selective decontamination of the digestive tract) in BMT centre with laminar flow HEPA filtration. Twelve out of 25 were autologous peripheral blood transplants, 11 were allografts and 2 were matched unrelated donors. The underlying diseases were Hodgkin`s disease, Multiple myeloma, AML, ALL, POEMS syndrome, Mantle zone lymphoma and Ewing`s sarcoma. Male to female ratio was 20:5 with age range of 16-65 years. SDD is a method used to abolish carriage of potentially pathogenic organisms. Oral ciprofloxacin, colistin, nystatin and amphotericin were given to eradicate the gut carriage and chlorhexidine mouth wash was used to decontaminate the oropharynx. Fever was observed in all patients who underwent BMT. Eight patients had a positive blood or line culture. The clinical isolates in these patients were coagulase negative staphycocci, Staphlococcus aureus, Enterococcus sp, Candida albicans. In all patients with positive blood or line culture fever settled with teicoplanin except two patients in whom line also had to be removed. Severe mucositis occurred in all (100%) patients. Only 2 (8%) patients had a culture proven oral thrush. Pneumonia with pleural effusion developed in 4 patients. The sputum in 1 patient grew Aspergillus sp. Diarrhoea occurred in 2 patients, 1 patient tested positive for Clostridium difficile toxin. It is concluded that fever and mucositis were the regular features of these patients where Gram positive organisms were isolated on blood culture. Only 2 deaths occurred during this period, one due to GVHD and another due to pneumonia (aspergillus). We conclude that the regimen used for the selective decontamination of the digestive tract was effective in eradicating Grams negative and yeast infections which cause more severe infections, are difficult to treat and associated with high mortality rate.

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