MICROBIAL CARRIAGE, SEPSIS, INFECTION AND ACUTE GVHD IN THE 1ST 25 BMT AT THE ROYAL-LIVERPOOL-CHILDRENS-HOSPITAL

The first 25 BMTs at the Royal Liverpool Children's Hospital (Alder He y) were performed between April 1987 and July 1991. The aim of this re port is to evaluate selective decontamination of the digestive tract ( SDD) during the first post-BMT month in this series of 14 allografts a nd 11 autografts. SDD is a method used to abolish carriage of potentia lly pathogenic microorganisms including yeasts, Staphylococcus aureus and Gram-negative bacilli (GNB). Chlorhexidine mouth wash was used to decontaminate the oropharynx, and neomycin, colistin (polymyxin E) and nystatin (NEOCON) were given to eradicate gut carriage. Oropharyngeal decontamination was successful in 48% of patients, gut carriage was a bolished in 60%, and eradication of the carrier state at both sites wa s achieved in 33%. A septic response was seen in 76% of children and 3 6% developed septicaemia (indigenous Gram-positive cocci only). A low carriage index for the target microorganisms during the study manoeuvr e of SDD was associated with negative blood cultures (p < 0.01). Acute GVHD occurred in 28% of allografts, but was seen in none of the succe ssfully decontaminated children (p < 0.05). It is concluded that septi caemia from yeasts and GNB, but not the septic response, were successf ully prevented by SDD.