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Hypoprothrombinemia in Febrile, Neutropenic Patients with Cancer: Association with Antimicrobial Suppression of Intestinal Microflora

Serial, twice-weekly prothrombin times were determined in 108 febrile, granulocytopenic patients with cancer who were prospectively randomized to receive empiric antimicrobial therapy with moxalactam plus ticarcillin (M/T) or tobramycin plus ticarcillin (T/T). Thirty of 54 patients given M/T and 13...

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Bibliographic Details
Published in:The Journal of infectious diseases 1984-08, Vol.150 (2), p.202-212
Main Authors: Conly, J. M., Ramotar, K., Chubb, H., Bow, E. J., Louie, T. J.
Format: Article
Language:English
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Summary:Serial, twice-weekly prothrombin times were determined in 108 febrile, granulocytopenic patients with cancer who were prospectively randomized to receive empiric antimicrobial therapy with moxalactam plus ticarcillin (M/T) or tobramycin plus ticarcillin (T/T). Thirty of 54 patients given M/T and 13 of 54 patients given T/T developed prothrombin times that were ⩾2 sec beyond control values (P < .001) after a mean of 6.5 days of antimicrobial therapy. Serious bleeding episodes were more frequent in the group given M/T than in that given T/T (10 and two patients, respectively; P ⩽ .05). Serial quantitative stool cultures revealed that both Escherichia coli and Bacteroides species were suppressed by ⩾5 log10, in eight of nine patients given M/T and in three of nine given T/T (P < .05, Fisher's exact test). A significant reduction of the population of E. coli and Bacteroides fragilis, organisms that are major producers of bacterially synthesized menaquinones, was associated with a high incidence of hypoprothrombinemia. These observations support the hypothesis that menaquinones may play an important physiological role in the maintenance of blood coagulation during episodic dietary deficiency of phylloquinone.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/150.2.202