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J Infect. 2014 Oct;69(4):341-351. doi: 10.1016/j.jinf.2014.06.004. Epub 2014 Jun 12.

Impact of peri-transplant vancomycin and fluoroquinolone administration on rates of bacteremia in allogeneic hematopoietic stem cell transplant (HSCT) recipients: a 12-year single institution study.

Author information

1
Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
2
Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY.
3
Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
#
Contributed equally

Abstract

BACKGROUND:

We analyzed the effect of peri-transplant prophylaxis on the epidemiology of bacteremia in a 12-year contemporary cohort of allogeneic HSCT recipients at our center.

METHODS:

This was an observational study of 1052 consecutive adult HSCT from 2000 to 2011. Formal prophylaxis with vancomycin only, fluoroquinolone (FQ) only, or vancomycin + FQ was implemented in 2006. The cumulative incidence of day 100 bacteremia was compared between the Early Period (2000-2005) and the Recent Period (2006-2011). Predictors for pre-engraftment bacteremia were analyzed with Cox-proportional hazard models in a subcohort of 821 HSCT who received myeloablative or reduced intensity conditioning (MA/RIC).

RESULTS:

The incidence of bacteremia decreased in the Recent Period (32% vs 27%; P = 0.002), whereas the rates of resistance in gram-negative rods (GNR) and vancomycin-resistant enterococci (VRE) were similar between the two Periods (P values are not statistically significant.) In multivariate analyses, prophylaxis with vancomycin only or vancomycin + FQ was protective (HR = 0.5; CI = 0.30-0.72) and (HR = 0.3; CI = 0.12-0.52, P < 0.01). Vancomycin or vancomycin + FQ eliminated viridans streptococcal bacteremia (VSB); vancomycin + FQ decreased GNR bacteremia (HR = 0.35; CI = 0.15-0.85).

CONCLUSIONS:

Vancomycin-based prophylaxis peri-transplant in MA/RIC HSCT was associated with elimination of VSB and may be considered at centers with high incidence of this infection.

KEYWORDS:

Allogeneic transplant; Bacteremia; Fluoroquinolone prophylaxis; Vancomycin prophylaxis; Viridans streptococci

PMID:
24931578
PMCID:
PMC4163089
DOI:
10.1016/j.jinf.2014.06.004
[Indexed for MEDLINE]
Free PMC Article

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