Prophylaxis with levofloxacin: impact on bacterial susceptibility and epidemiology in a hematopoietic stem cell transplant unit

Abstract

BackgroundThe emergence of resistance has been demonstrated in cancer treatment centers where prophylaxis with fluoroquinolone is used.ObjectiveConsidering the importance of epidemiological monitoring as a strategy in choosing protocols involving antibiotics, this study aimed to evaluate the emergence of quinolone resistance and changes in the local epidemiology in a hematopoietic stem cell transplant service.MethodsFor this study, 60 positive cultures before the prophylactic use of levofloxacin (period A: 2007-2008) and 118 cultures after starting the use of prophylactic levofloxacin (period B: 2010-2011) were evaluated.ResultsResistance increased for all the different types of bacteria isolated (from 46.0% to 76.5%; p-value = 0.0002). Among Gram-negative bacteria, resistance increased from 21.4% to 60.7% (p-value = 0.0163) and among Gram-positive bacteria, it increased from 55.6% to 82.9% (p-value = 0.0025). The use of levofloxacin increased from 19.44 defined daily doses per 1,000 patient-days in period A to 166.64 in period B. The use of broad spectrum antibiotics remained unchanged. Considering bacteria associated with infection, 72 and 76 were isolated in periods A and B, respectively. There was a reduction in the rate of Gram-negative bacteria in cultures associated with infection (3.81 vs. 2.00 cultures/1,000 patient-days; p-value = 0.008).ConclusionThe study of prophylaxis with levofloxacin demonstrated that there was a decrease in infections by Gram-negative bacteria; however, bacterial resistance increased, even though the use of broad-spectrum antibiotics remained unchanged. Constant monitoring of local epidemiology combined with research on clinical outcomes is needed to evaluate the effectiveness of prophylaxis.© 2014 Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular. All rights reserved.

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

“…Among the 9 studies selected for the meta-analysis, 6 were retrospective single-center studies [ 33–38 ] and 3 were prospective studies [ 39–41 ], 2 of which were randomized [ 40 , 41 ]; 1 was also multicentric [ 41 ]. Two studies included only patients with acute lymphoblastic leukemia (ALL) [ 39 , 40 ], 1 only patients with acute myeloid leukemia (AML) [ 37 ], 2 both ALL and AML patients [ 33 , 42 ], 1 only patients undergoing autologous HSCT (auto-HSCT) [ 35 ], 2 both auto- and allogenic HSCT (allo-HSCT) [ 34 , 36 ], and 1 all groups of patients [ 41 ]. Two of the 6 studies on ALL patients studied relapsed ALL (rALL) [ 33 , 41 ].…”

Random Mutation and Natural Selection In Competitive and Non-Competitive Environments

“…To generalize this effect to all cases of drug-resistance misses the point of how to prevent drug resistance. Lopes and his co-authors in Prophylaxis with levofloxacin: impact on bacterial susceptibility and epidemiology in a hematopoietic stem cell transplant unit [14] report that prophylaxis with quinolones in their immune compromised patients reduces the incidence of gram-negative infections but at the expense of emergence of drug resistant variants. If the drug-resistance occurs simply by increasing the activity of an efflux pump is a different matter when considering the evolution of drug-resistance at individual metabolic pathways to individual drugs.…”

Complicaciones infecciosas en pacientes con leucemia mieloide aguda

“…Actualmente es tema de debate el uso de PA aún en pacientes de alto riesgo ya que puede exponer a los mismos a la colonización y desarrollo de infecciones por microorganismos multirresistentes, efectos adversos, pérdida de la eficacia de la misma, mayor mortalidad y aumento de costos. Esta controversia ya ha sido planteada desde mediados de los años 90 (13,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”