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J Infect. 2018 Jul;77(1):68-74. doi: 10.1016/j.jinf.2018.05.004. Epub 2018 Jun 6.

Impact of fluoroquinolone prophylaxis during neutropenia on bloodstream infection: Data from a surveillance program in 8755 patients receiving high-dose chemotherapy for haematologic malignancies between 2009 and 2014.

Author information

1
Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Center, and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany . Electronic address: winfried.kern@uniklinik-freiburg.de.
2
Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany.
3
Department of Environmental Health Sciences and Hospital Infection Control, University Hospital and Medical Center, and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany.
4
Division of Hematology, Oncology, and Stem Cell Transplantation, Department of Medicine I, University Hospital and Medical Center, Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany.
5
Institute for Hygiene and Environmental Medicine, Charité University Medical Center, Berlin, Germany.
6
Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
7
Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland; Division of Infectious Diseases, Department of Medicine II, University Hospital and Medical Center, and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Germany.

Abstract

OBJECTIVES:

Antibacterial chemoprophylaxis with fluoroquinolones (FQPx) has been commonly used in cancer patients with neutropenia, but its efficacy has been challenged by the emergence of fluoroquinolone resistance.

METHODS:

The impact of FQPx on bloodstream infections (BSI) during neutropenia after high-dose chemotherapy for haematologic malignancies was evaluated through a multicenter hospital infection surveillance system for the period 2009-2014.

RESULTS:

Among 8755 patients (4223 allogeneic [allo-] HSCT, 3602 autologous [auto-] HSCT, 930 high-dose chemotherapy for acute leukemia [HDC]), 5302 (61%) had received FQPx. Administration of FQPx was associated with fewer Gram-negative BSI in the overall study cohort patients (4.6% vs. 7.7%, adjusted subdistribution hazard ratio [aSHR] 0.59, 95%CI 0.50-0.70), in patients with HDC (3.7% vs. 9.2%, adjusted subdistribution hazard ratio [aSHR] 0.40, 95%CI 0.22-0.70) and auto-HSCT patients (4% vs. 9%, aSHR 0.43, 95%CI 0.33-0.56). In HDC patients, FQPx was associated with a marked reduction in all-cause mortality during neutropenia (2.3% vs. 7.8%, aSHR 0.30, 95%CI 0.15-0.58). Patients receiving FQPx had significantly more BSIs due to ESBL-positive Enterobacteriacea (0.8 vs. 0.3%, RR 2.2, 95%CI 1.17-4.26). BSIs by MRSA (n = 5) and VRE (n = 11) were rare in our cohort.

CONCLUSIONS:

As used in the participating centers, FQPx was associated with reduced Gram-negative BSI and improved survival among HDC patients. Among HSCT patients, the benefits were less clear. If adapted to local resistance patterns and patient characteristics, FQPx still may be useful in the management of patients with haematologic malignancies.

KEYWORDS:

Antibiotic prophylaxis; Bloodstream infection; Fluoroquinolone; Neutropenia

PMID:
29883599
DOI:
10.1016/j.jinf.2018.05.004

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