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Respiratory failure elicited by streptococcal septicaemia in patients treated with cytosine arabinoside, and its prevention by penicillin

Respiratorische Insuffizienz als Folge einer Streptokokkenseptikämie bei Patienten unter Cytosin Arabinosid-Therapie und ihre Prävention durch Penicillin

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Summary

In order to prevent septicaemia with streptococci, 20 consecutive selectively decontaminated patients on intermediate high-dose Ara-C treatment for malignant haematological disease were given pencillin G. The incidence of infection with streptococci decreased from 0.76 per episode (14 patients, 17 episodes) for controls who did not receive penicillin G to 0.11 per episode in the prophylaxis group (20 patients, 26 episodes). Simultaneously, a decrease in the incidence of respiratory failure was observed, i. e. 0.52 per episode for controls and 0.19 per episode for patients on penicillin G. The results suggest that septicaemia with streptococci triggers the development of noncardiogenic pulmonary oedema in patients with pre-existing damage of the lung due to aggressive cytotoxic treatment. This suggestion is supported by the sequence of events, regarding the occurrence of infection and respiratory failure and the results of measurements of antileukoprotease serum concentrations, a paramenter for pulmonary capillary leakage. Taking into account the data in the literature and the results of the present study, the conclusion is drawn that in patients treated with (intermediate) high dose Ara-C, prevention of streptococcal septicaemia is associated with a decrease in the incidence of respiratory failure.

Zusammenfassung

20 Patienten, die konsekutiv unter selektiver Dekontamination wegen maligner hämatologischer Erkrankungen mit einer mittelgradigen Hoch-Dosis-Ara-C-Therapie standen, erhielten zur Prävention von Streptokokkenseptikämien Penicillin G. Verglichen mit einer Kontrollgruppe (14 Patienten, 17 Zyklen), in der ohne Penicillinprophylaxe 0,76 Streptokokkeninfektionen pro Zyklus auftraten, war die Inzidenz dieser Komplikation unter Penicillin G-Prophylaxe bei 20 Patienten in 26 Zyklen mit 0,11 Streptokokkeninfektionen pro Therapiezyklus geringer. Zugleich wurde beobachtet, daß im Vergleich zur Kontrollgruppe mit 0,19 gegenüber 0,52 Fällen pro Zyklus bei Patienten unter Penicillin-G-Prophylaxe weniger häufig eine respiratorische Insuffizienz auftrat. Aus den Ergebnissen der Studien läßt sich schließen, daß die Streptokokkenseptikämie einen Trigger für die Entstehung eines nicht kardiogenen Lungenödems bei Patienten mit vorbestehender Lungenschädigung infolge aggressiver Zytostatikatherapie darstellt. Diese Annahme wird unterstützt durch den Ablauf der Ereignisse, das gemeinsame Auftreten von Infektion und respiratorischer Insuffizienz und die Meßwerte für die Antileukoprotease-Konzentrationen im Serum, einen Parameter für erhöhte Durchlässigkeit im Lungenkapillarbett. Aus publizierten Daten und Ergebnissen der vorliegenden Studie wird geschlossen, daß die Prävention der Streptokokkenseptikämie bei Patienten, die eine (mittelgradige) Hoch-Dosis-Therapie mit Ara-C erhalten, auch die Inzidenz der respiratorischen Insuffizienz bei diesen Patienten vermindert.

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Authors and Affiliations

  1. Dept. of Infectious Diseases, University Hospital Leiden, P. O. Box 9600, NL-2300 RC, Leiden, The Netherlands

    H. F. L. Guiot Ph. D., J. W. M. van der Meer M. D. & R. van Furth M. D.

  2. Dept. of Haematology, University Hospital Leiden, P. O. Box 9600, NL-2300 RC, Leiden, The Netherlands

    W. G. Peters M. D., P. J. van den Broek M. D. & R. Willemze M. D.

  3. Dept. of Pulmonology, University Hospital Leiden, P. O. Box 9600, NL-2300 RC, Leiden, The Netherlands

    J. A. Kramps Ph. D.

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  1. H. F. L. Guiot Ph. D.
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Guiot, H.F.L., van der Meer, J.W.M., van Furth, R. et al. Respiratory failure elicited by streptococcal septicaemia in patients treated with cytosine arabinoside, and its prevention by penicillin. Infection 18, 131–137 (1990). https://doi.org/10.1007/BF01642100

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