1887

Abstract

Fluoroquinolone prophylaxis during haematopoietic cell transplantation (HCT) can lead to antimicrobial resistance (AMR). Identifying the groups of patients that have the highest likelihood of benefiting from prophylactic antimicrobials is important for antimicrobial stewardship (AMS).

We aimed to identify groups of HCT recipients that have the highest likelihood of benefiting from prophylactic fluroquinolones.

All admissions for HCT in a tertiary centre between January 2020 and December 2022 ( = 400) were retrospectively studied. Allogeneic HCT (allo-HCT) recipients had prophylaxis with ciprofloxacin during the chemotherapy-induced neutropenia, while autologous HCT (auto-HCT) recipients did not. Bacteraemias were recorded when non-contaminant bacterial pathogens were isolated in blood cultures.

Allo-HCT was performed for 43.3 % (173/400) of patients and auto-HCT was performed for 56.7 % (227/400). A bacteraemia was documented in 28.3 % (113/400) of cases. Allo-HCT recipients were more likely to have a Gram-positive bacteraemia (20.8%, 36/173, vs 10.1%, 23/227, = 0.03), while a difference was not observed for Gram-negative bacteraemias (18.5%, 32/173 vs 18.1%, 41/227, = 0.91). Among auto-HCT recipients not receiving ciprofloxacin prophylaxis, patients with germ cell tumours had the highest probability ( for trend 0.09) of recording any bacteraemia (43.5%, 10/23) followed by patients with lymphomas (32.5%, 13/40), other auto-HCT indications (22.2%, 2/9), multiple myeloma (22.1%, 29/131) and multiple sclerosis (12.5%, 3/24). The higher number of bacteraemias in patients with germ cell tumours was primarily driven by Gram-negative pathogens.

Ciprofloxacin prophylaxis was associated with a reduced incidence of Gram-negative bacteraemias in allo-HCT recipients. Auto-HCT recipients due to germ cell tumours, not receiving ciprofloxacin prophylaxis, recorded the highest incidence of bacteraemias and represent a possible target group for this intervention.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001847
2024-06-26
2024-07-15
Loading full text...

Full text loading...

/deliver/fulltext/jmm/73/6/jmm001847.html?itemId=/content/journal/jmm/10.1099/jmm.0.001847&mimeType=html&fmt=ahah

References

  1. Schuster MG et al. Open Forum Infectious Diseases US: Oxford University Press;
    [Google Scholar]
  2. Gafter-Gvili A, Fraser A, Paul M, Vidal L, Lawrie TA et al. Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy. Cochrane Database Syst Rev 2012; 1:CD004386 [View Article] [PubMed]
    [Google Scholar]
  3. Hoffman T, Atamna A, Litchevsky V, Amitai I, Yahav D. Fluoroquinolone prophylaxis during conventional chemotherapy or hematopoietic stem cell transplantation for acute leukemia - pros and cons. Acta Haematol 2024; 147:186–197 [View Article] [PubMed]
    [Google Scholar]
  4. New restrictions and precautions for the use of fluoroquinolones. DTB 2019; 57:118 [View Article]
    [Google Scholar]
  5. Young J-A, Weisdorf DJ. Infections in recipients of hematopoietic stem cell transplants. In Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases vol 3425 2015
    [Google Scholar]
  6. Carreras E, Dufour C, Mohty M, Kröger N. The EBMT Handbook: Hematopoietic Stem Cell Transplantation and Cellular Therapies 2019
    [Google Scholar]
  7. Knight SR, Ho A, Pius R, Buchan I, Carson G et al. Risk stratification of patients admitted to hospital with covid-19 using the ISARIC WHO clinical characterisation protocol: development and validation of the 4C mortality score. BMJ 2020; 370:m3339 [View Article] [PubMed]
    [Google Scholar]
  8. Dargère S, Cormier H, Verdon R. Contaminants in blood cultures: importance, implications, interpretation and prevention. Clin Microbiol Infect 2018; 24:964–969 [View Article] [PubMed]
    [Google Scholar]
  9. Baltas I, Kavallieros K, Konstantinou G, Koutoumanou E, Gibani MM et al. The effect of ciprofloxacin prophylaxis during haematopoietic cell transplantation on infection episodes, exposure to treatment antimicrobials and antimicrobial resistance: a single-centre retrospective cohort study. JAC Antimicrob Resist 2024; 6:dlae010 [View Article] [PubMed]
    [Google Scholar]
  10. O’Brien SN, Blijlevens NMA, Mahfouz TH, Anaissie EJ. Infections in patients with hematological cancer: recent developments. Hematology Am Soc Hematol Educ Program 2003; 2003:438–472 [View Article] [PubMed]
    [Google Scholar]
  11. Collin BA, Leather HL, Wingard JR, Ramphal R. Evolution, incidence, and susceptibility of bacterial bloodstream isolates from 519 bone marrow transplant patients. Clin Infect Dis 2001; 33:947–953 [View Article] [PubMed]
    [Google Scholar]
  12. Arango JI, Restrepo A, Schneider DL, Callander NS, Ochoa-Bayona JL et al. Incidence of Clostridium difficile-associated diarrhea before and after autologous peripheral blood stem cell transplantation for lymphoma and multiple myeloma. Bone Marrow Transplant 2006; 37:517–521 [View Article] [PubMed]
    [Google Scholar]
  13. Gassas RS, Absi AN, Alghamdi AA, Alsaeed AS, Alamoudi SM et al. Early infection in post-autologous hematopoietic stem cell transplant patients. SMJ 2021; 42:847–852 [View Article]
    [Google Scholar]
  14. Amer R, Salameh H, Mosleh S, Abu-Taha A, Hamayel H et al. Epidemiology of early infections and predictors of mortality after autologous hematopoietic stem-cell transplantation among multiple myeloma, Hodgkin, and non-Hodgkin lymphoma: the first experience from Palestine. BMC Infect Dis 2022; 22:725 [View Article] [PubMed]
    [Google Scholar]
  15. UK Health Security Agency English surveillance programme for antimicrobial utilisation and resistance (ESPAUR); 2023 https://assets.publishing.service.gov.uk/media/6555026e544aea000dfb2e19/ESPAUR-report-2022-to-2023.pdf
  16. Desai AV, Heneghan MB, Li Y, Bunin NJ, Grupp SA et al. Toxicities of busulfan/melphalan versus carboplatin/etoposide/melphalan for high-dose chemotherapy with stem cell rescue for high-risk neuroblastoma. Bone Marrow Transplant 2016; 51:1204–1210 [View Article] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001847
Loading
/content/journal/jmm/10.1099/jmm.0.001847
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error