Protective isolation: who needs it?

Infection continues to be a major cause of morbidity and mortality in neutropenic patients following chemotherapy or bone marrow transplantation (BMT). Concerted efforts have been made to protect these patients from infection during the neutropenic period. Elaborate protocols to protect the patient from both intrinsic and extrinsic pathogens have been devised, ranging from simple single room isolation to laminar air flow units (LAFs), in association with varying degrees of antibiotic decontamination of the digestive tract. Comparative rates of infection using these techniques have varied in different studies, and their use has been somewhat controversial. More recently, prophylactic quinolone administration to neutropenic patients has significantly decreased the incidence of both Gram-negative septicaemia and pyrexial episodes, probably superseding any advantages which may have been conferred by previous regimens. LAFs with high efficiency particulate air filtration still appear to be the best means of protection against aspergillosis, but are expensive and would not be available for the majority of neutropenic patients. They should probably be allocated to patients who are most at risk; BMT recipients or others who may be expected to have a prolonged neutropenic period.