Blood stream infections after allogeneic stem cell transplantation: a single‐center experience with the use of levofloxacin prophylaxis

Abstract

Blood stream infections (BSIs) remain one of the major causes of morbidity and mortality for patients receiving an allogeneic hematopoietic stem cell transplantation (HSCT). In the present study, we evaluated the incidence and characteristics of BSI within 1 year after allogeneic HSCT in 269 consecutive adult patients who received antibacterial prophylaxis with levofloxacin. Cumulative incidence of BSI was 12% (95% confidence interval, 8-16%). Bacteria were responsible for 30 out of the 32 BSI, while fungi were responsible for 2 episodes of BSI. The median onset of BSI was day 8 (range 1-328 days) post transplant, and 66% of BSI occurred before neutrophil recovery. Gram-positive organisms accounted for 60% (n=18) of bacteremia, and gram-negative isolates for 40% (n=12) of the cases. Coagulase-negative staphylococci were the most commonly isolated gram-positive pathogens (53% of the cases), while Escherichia coli was the most commonly isolated gram-negative bacteria (58% of the cases). Candida albicans and Candida guillermondii were isolated from patients with candidemia. Resistance to fluoroquinolones (FQ) was common with 13% of gram-positive isolates being susceptible to FQ, while 50% of the gram-negative rods were susceptible to FQ. Crude mortality and mortality attributable to BSI were both 3% (1 of 32). In conclusion, our data suggest that despite the emergence of antibiotic resistance, FQ prophylaxis may be considered an appealing approach in allogeneic HSCT recipients and is also worth evaluating in randomized studies.

The Changing Epidemiology of Bloodstream Infections and Resistance in Hematopoietic Stem Cell Transplantation Recipients

“…This rate is lower than that noted in other units of our hospital and those in other studies [3,20,27,28]. Busca et al reported that quinolone use may induce the resistance rate against quinolone itself and even against some other antibiotics [28]. However, despite routine use of quinolone prophylaxis, increased rates of resistance have not been observed in patients undergoing prophylaxis.…”

Epidemiology of bloodstream infections in patients with acute myeloid leukemia undergoing levofloxacin prophylaxis

“…However, during the study period there was a lower rate of fluoroquinolones resistance amongst bloodstream E. coli hospital isolates (29-38%) and there were few cases of bloodstream infections caused by ESBL-producers E. coli , with resistance to fluoroquinolones in 76.3% of strains [12]. Amongst patients undergoing allogenic transplant and levofloxacin prophylaxis, coagulase-negative staphylococci were the most commonly isolated Gram-positive pathogens and E. coli was the most commonly isolated Gram-negative bacteria [13]. Resistance to fluoroquinolones was 87% amongst Gram-positive isolates and 50% amongst Gram-negative rods.…”

Infections Caused by Stenotrophomonas maltophilia in Recipients of Hematopoietic Stem Cell Transplantation

“…Despite the emergence of antimicrobial resistance, fluoroquinolone prophylaxis may be considered as an appealing option in recipients of HSCT. However, their usefulness in prophylaxis in allogeneic HSCT should be evaluated in randomized trials (112, 113). …”