Prevention of infections

More than 80 per cent of infections in the neutropenic patient can be traced to host endogenous flora. Surveillance cultures in these patients are useful, although they may have a low predictive value. They provide hints of the possible causative micro-organism and may influence therapeutic decisions. They are usually limited to potential sites of infection such as cultures from the nares, throat, perianal area, and stool for bacteria, fungi, and viruses. Routine sterilization with non-absorbable oral antimicrobials consisting of colistin, neomycin, nystatin, and amphotericin has been advocated. Some of these antimicrobials are often poorly tolerated. Systemic antibiotics such as ciprofloxacin have been successfully used to prevent Gram-negative infections in neutropenic patients. Unfortunately, increasing and indiscriminate use in the community has diminished their value as resistant bacteria have developed. Another problem with this approach is superinfection with Gram-positive organisms. Ancillary measures such as handwashing, special diets, and reverse isolation are all valuable preventive measures.

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