Bacteremia during neutropenic episodes in children undergoing hematopoietic stem cell transplantation with ciprofloxacin and penicillin prophylaxis

Abstract

Bacteremia during neutropenic episodes is a cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). We have used oral ciprofloxacin and penicillin V, from the start of the conditioning regimen until engraftment, for the prophylaxis of bacterial infection. The objective of this study was to retrospectively analyze the prevalence of and risk factors for breakthrough bacteremia during neutropenic episodes in autologous and allogeneic HSCT patients. There were 215 patients enrolled, with a median age of 8.32 years (range 0.51-21.64 years) between 2002 and 2014. The common underlying diseases were thalassemia and acute leukemia. Bacteremia was documented in 33 patients (15.3 %), with 39 microorganisms isolated. Escherichia coli (28.2 %) and Streptococcus viridans (12.8 %) were the most commonly isolated Gram-negative and Gram-positive bacteria, respectively. Multidrug resistant strains were found in 32 and 14.3 % of Gram-negative and Gram-positive bacteria, respectively. Risk factors for bacteremia were receiving anti-thymocyte globulin (ATG) [odds ratio (OR) 2.44, 95 % confidence interval (CI) 1.06-5.65, P = 0.037] and umbilical cord blood as a stem cell graft (OR 6.60, 95 % CI 1.04-41.83, P = 0.045). In conclusion, the prevalence of bacteremia was 15.3 % and the use of ATG and cord blood were risk factors for bacteremia during neutropenic episodes.

Levofloxacin prophylaxis in hospitalized children with leukemia: A cost‐utility analysis

“…Our literature search identified 1757 unique references, of which 21 articles about the effectiveness of antibiotic prophylaxis in children were included (Figurs S1). 7,10,12,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] The methods and relevant results from these 21 articles are summarized in Table S3.…”

Multiple mechanisms contributing to ciprofloxacin resistance among Gram negative bacteria causing infections to cancer patients

“…Fluoroquinolones (FQs) are currently the primary antibiotics for antimicrobial prophylaxis in immunosuppressed cancer patients with the attendant risk of infection caused by the cytotoxic chemotherapy or the disease itself 1 , 2 . The main argument against this practice has been the selection of resistance to FQs.…”

Antimicrobial Prophylaxis and Modifications of the Gut Microbiota in Children with Cancer

“…Widjajanto et al conducted a similar study in 110 children with ALL who were undergoing induction treatment and compared the effects of prophylaxis with ciprofloxacin with those of placebo; the result was disappointing, with a greater risk of fever and sepsis and increased mortality among those who received ciprofloxacin [25]. The dosage of ciprofloxacin has varied among the studies: Yousef et al used ciprofloxacin at a prophylactic dosage of 25 mg/kg/day [26], Laoprasopwattana at a dosage of 20 mg/kg/day [24], Choeyprasert at 20-30 mg/kg/day in two divided doses in combination with penicillin sodium V 25-50 mg/kg/day in four doses [27], while Al Omar et al administered it at a dosage of 10 mg/kg/day divided into two doses every 12 h [28].…”