Work

Levofloxacin Prophylaxis for Autologous Stem Cell Transplant: A Second Look

Year: 2019

Type: article

Abstract: Introduction Autologous stem cell transplant patients (ASCT) are at risk for bacterial. Antibacterial prophylactic strategy is variable among centers. Fluoroquinolone prophylaxis in ASCT patients has not been found to add a survival benefit. We performed a retrospective review of patients undergoing ASCT with and without bacterial prophylaxis to compare endpoints of interest. Methods At our institution, patients undergoing ASCT for multiple myeloma (MM) receive levofloxacin 500 mg daily as prophylaxis, while lymphoma patients do not. We retrospectively examined MM or lymphoma patients undergoing ASCT between July of 2015 and 2018 for bacteremia episodes. MM patients received melphalan and lymphoma patients received BEAM. All patients received growth factor support. Clinical and microbial data was recorded and analyzed using SPSS. Results In total, 172 patients underwent ASCT for lymphoma and 343 for MM. Seventeen percent (30/172) of lymphoma patients and 5.5% (19/324) of MM patients had febrile neutropenic episodes associated with bacteremia. Relative risk was 3.1 [1.83 – 5.43, p < 0.001]. Median time to positive blood cultures was 5 [0 – 9] days for lymphoma patients and 7 [4 – 9] days for MM patients. All but two patients had a median absolute neutrophil count (ANC) of zero at the time of bacteremia. There were no resistant organisms in the lymphoma group while 37% (7/19) of the infections in the MM group were resistant to levofloxacin among other drugs, including 4 extended-spectrum beta-lactam (ESBL) E. coli isolates. The incidence of CDI was 13.4% in the lymphoma group and 8.2% in the MM group with p=0.06. Patients with resistant isolates required longer time to clear blood cultures. Two infection-related deaths occurred in the MM group, one from CDI colitis and one from Vancomycin-resistant Enterococcus bacteremia (Table 1). Discussion Fluoroquinolone prophylaxis resulted in less blood stream infection episodes but more breakthrough infections with resistant isolates. There was no statistically significant difference between the rates of CDI infections despite a trend to lower incidence in the prophylaxis group. Bacteremia was more difficult to treat for the resistant isolates. There were two infection-related mortalities in the prophylaxis group. In the era of antimicrobial resistance, further reevaluation of the utility of fluoroquinolone prophylaxis should be carefully weighed against the risks.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2018.12.442