Table 3.

Clinical studies of protective isolation with gut decontamination in HCT patients

Intervention	Control	Outcomes (Intervention v Control)	References
Randomized trials
Protective isolation (LAF* isolation, skin cleansing, sterile diets) + oral antibiotic decontamination (n=45)	Oral antibiotic decontamination (n=44)	Decreased risk of infection Fewer patients with septicemia Fewer days with septicemia Longer time to first major infection Later onset GVHD (only in aplastic anemia patients) No difference in survival Of note, adherence to oral antibiotic decontamination was poor	Buckner, 197817
LAF* isolation + oral antibiotic decontamination (n=36)	Conventional rooms +hand-washing and mask precautions (n=31)	Decreased incidence of infections after engraftment Later onset acute GVHD Trend toward decreased incidence of grade II to IV aGVHD; not statistically significant Increased survival	Navari, 198418
LAF* isolation + oral non-absorbable antibiotics + prophylactic systemic antibiotics (n=54)	LAF* + oral nonabsorbable antibiotics (n=68)	Fewer episodes of septicemia No difference in incidence or severity of GVHD No difference in mortality	Petersen, 198619
Conventional rooms + prophylactic systemic antibiotics (n=45)	Conventional rooms + prophylactic granulocyte infusions (n=67)	No difference in incidence of septicemia or local major infections No difference in GVHD incidence No difference in mortality	Petersen, 198620
LAF* + prophylactic systemic antibiotics (n=49)	Conventional rooms+ prophylactic systemic antibiotics (n=50)	Decreased septicemia Decreased major local infections (borderline significance) No difference in GVHD incidence No difference in mortality	Petersen, 198721
Conventional rooms + ciprofloxacin + metronidazole gut decontamination (n=68)	Conventional rooms + ciprofloxacin gut decontamination (n=66)	Decreased incidence of acute GVHD No difference in chronic GVHD No difference in OS	Beelen, 199922
Observational trials
LAF* isolation + oral antibiotic decontamination (n=39)	Conventional rooms + oral antibiotic decontamination (n=91)	Decreased incidence of acute GVHD Increased long-term survival	Storb, 198323
LAF* isolation +oral and topical antibiotic decontamination (n=26)	Conventional rooms + barrier nursing +oral and topical antibiotic decontamination (n=22)	No difference in GVHD incidence No difference in mortality	Mahmoud, 198424
Strict reverse isolation** + oral non-absorbable antibiotics, complete gut decontamination (n=26)	Barrier nursing + oral non-absorbable antibiotics, selective gut decontamination (n=15)	Fewer days of fever and fewer infections Trend towards decreased GVHD although not statistically significant	Schmeiser, 198825
LAF* + complete antibiotic oral decontamination (n=44)	LAF* + selective decontamination (n=21)	Fewer infections Decreased acute and chronic GVHD incidence Lower combined TRM or chronic GVHD incidence	Vossen, 199026
Sustained growth suppression of anaerobic bacteria with oral nonabsorbable and systemic antibiotics (n=41)	Incomplete growth suppression of anaerobic bacteria despite oral nonabsorbable and systemic antibiotics (n=153)	Decreased incidence of acute GVHD	Beelen, 199227
Protective isolation with either LAF* or HEPA filters (n=423 8)	Conventional isolation (n=827)	No difference in acute or chronic GVHD incidence Decreased TRM and overall mortality in the first 100 days post-transplant	Passweg, 199828
Protective isolation + successful gut decontamination with oral nonabsorbable and systemic antibiotics (n=57)	Protective isolation - successful gut decontamination despite oral nonabsorbable and systemic antibiotic (n=55)	Decreased infectious risk Decreased incidence of acute GVHD	Vossen, 201429

^*LAF= Laminar air flow

^**Reverse isolation was achieved in sterile plastic isolators