Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination

Invasive fungal infections (IFI) are increasingly diagnosed in patients und ergoing allogeneic BMT, We have previously shown that the addition of metro nidazole to ciprofloxacin for gastrointestinal bacterial decontamination si gnificantly reduces the incidence of grades II-IV aGVHD by reduction of the anaerobic intestinal bacterial flora, Here, we found that the combined use of ciprofloxacin, metronidazole and fluconazole as antifungal prophylaxis increased intestinal yeast colonization when compared to ciprofloxacin and fluconazole alone (P < 0.01), Based on the EORTC criteria, a total of 18 ou t of 134 study patients developed IFI: seven of 68 (10%) patients who recei ved metronidazole compared to 11 of the 66 (17%) patients decontaminated wi thout metronidazole developed IFI (log-rank P = 0.36), Lethal IFI occurred in two of seven patients receiving metronidazole and in four of 11 patients without anaerobic decontamination, In conclusion, bacterial intestinal dec ontamination using metronidazole as an antibiotic with activity against mos t anaerobic intestinal bacteria significantly increases the intestinal yeas t burden without influencing the incidence of IFI in patients undergoing al logeneic BMT.