Significance of Pseudomonas aeruginosa in the Patient with Leukemia or Lymphoma

Abstract

Study of patients hospitalized at the Baltimore Cancer Research Center with acute leukemia or advanced lymphoma showed that Pseudomonas aeruginosa was acquired frequently in the hospital, especially by patients with acute nonlymphocytic leukemia (ANLL). Colonized ANLL patients with prolonged granulocytopenia nearly always became infected and generally became bacteremic rapidly; these infections were the major cause of septicemia at this center. Other species of Pseudomonas frequently colonized but rarely invaded even the profoundly granulocytopenic patient. Empiric treatment with carbenicillin and gentamicin cured more than half of the febrile granulocytopenic patients with cancer, and nearly all survived at least four to seven days unless granulocytopenia persisted. Systemic carbenicillin and oral gentamicin were apparently associated with the development of carbenicillin- and/or gentamicin-resistant strains of P. aeruginosa. A combination of reverse isolation in laminar air flow rooms plus treatment with oral nonabsorbable antibiotics in a prospective randomized trial reduced markedly the rates of acquisition or infections with this organism in patients with ANLL.