Clinical and microbiological impact of discontinuation of fluoroquinolone prophylaxis in patients with prolonged profound neutropenia

Verlinden, Anke; Jansens, Hilde; Goossens, Herman; Velde, Ann L. Van de; Schroyens, Wilfried; Berneman, Zwi N.; Gadisseur, Alain

doi:10.1111/ejh.12345

Cited by 30 publications

(26 citation statements)

References 24 publications

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“…These alternative tools include clinical scores [ 5 , 6 ], ultrasonography [ 7 ], magnetic resonance imaging (MRI) [ 8 ] and dual-energy computed tomography (DECT) [ 8 , 9 ]. Ultrasound (US) features of gouty and CPP arthritis have been well described [ 5 , 8 , 10 , 11 ], and the technique has been proposed as a convenient diagnostic tool for crystal-induced arthritis [ 12 ]. Although the typical US signs of MSU and CPP are well defined [ 10 , 13 – 17 ], the accuracy (or reliability) of the technique remains not totally clear.…”

Section: Introductionmentioning

confidence: 99%

A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis

Zufferey¹,

Valcov²,

Fabreguet³

et al. 2015

Arthritis Res Ther

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IntroductionThe performance of ultrasound (US) in the diagnosis of acute gouty (MSU) arthritis and calcium pyrophosphate (CPP) arthritis is not yet well defined. Most studies evaluated US as the basis for diagnosing crystal arthritis in already diagnosed cases of gout and few prospective studies have been performed.MethodsOne hundred nine consecutive patients who presented an acute arthritis of suspected microcrystalline arthritis were prospectively included. All underwent an US of the symptomatic joints(s) and of knees, ankles and 1st metatarsopalangeal (MTP) joints by a rheumatologist “blinded” to the clinical history. 92 also had standard X-rays. Crystal identification was the gold standard.ResultsFifty-one patients had MSU, 28 CPP and 9 had both crystals by microscopic analysis. No crystals were detected in 21. One had septic arthritis. Based on US signs in the symptomatic joint, the sensitivity of US for both gout and CPP was low (60 % for both). In gout, the presence of US signs in the symptomatic joint was highly predictive of the diagnosis (PPV = 92 %). When US diagnosis was based on an examination of multiple joints, the sensitivity for both gout and CPP rose significantly but the specificity and the PPV decreased. In the absence of US signs in all the joints studied, CPP arthritis was unlikely (NPV = 87 %) particularly in patients with no previous crisis (NPV = 94 %). X-ray of the symptomatic joints was confirmed to be not useful in diagnosing gout and was equally sensitive or specific as US in CPP arthritis.ConclusionsArthrocenthesis remains the key investigation for the diagnosis of microcrystalline acute arthritis. Although US can help in the diagnostic process, its diagnostic performance is only moderate. US should not be limited to the symptomatic joint. Examination of multiple joints gives a better diagnostic sensitivity but lower specificity.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0701-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis

Zufferey¹,

Valcov²,

Fabreguet³

et al. 2015

Arthritis Res Ther

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“…These studies and a meta-analysis underlined the benefits in terms of the risk of fever and documented bacterial infection, as well as mortality [ 46 ]. However, routine use of these strategies was associated with an increased rate of bacterial resistance [ 46 – 49 ]. These studies were performed in non-critically ill patients [ 46 ].…”

Section: Results and Recommendationsmentioning

confidence: 99%

Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF)

Schnell

Azoulay

Benoît

et al. 2016

Ann. Intensive Care

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Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0189-6) contains supplementary material, which is available to authorized users.

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“…Second, based on a recent estimate, 16 the direct health care costs due to antimicrobial resistance associated with increased broad‐spectrum antibiotic use are negligible: $0.00‐$0.01 per standard unit of antibiotics; though indirect costs, not included in our model, are estimated to be higher. Third, the long‐term impacts of routine fluoroquinolone prophylaxis on antimicrobial resistance and health outcomes are unclear 15,27,28 . Fourth, it is unclear how rates and patterns of antimicrobial resistance compare between levofloxacin prophylaxis and no prophylaxis groups, given the potential effects of prophylaxis on rates of exposure to other broad‐spectrum antibiotics and the effects of chemotherapy itself on resistance patterns 10,29 …”

Section: Methodsmentioning

confidence: 99%

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

Maser

Pelland‐Marcotte

Alexander

et al. 2020

Pediatric Blood & Cancer

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Background Infections are common and are a major cause of morbidity and mortality during treatment of childhood leukemia. We evaluated the cost effectiveness of levofloxacin antibiotic prophylaxis, compared to no prophylaxis, in children receiving chemotherapy for acute myeloid leukemia (AML) or relapsed acute lymphoblastic leukemia (ALL). Procedures A cost‐utility analysis was conducted from the perspective of the single‐payer health care system using a lifetime horizon. A comprehensive literature review identified available evidence for effectiveness, safety, costs of antibiotic prophylaxis in children with leukemia, and health utilities associated with the relevant health states. The effects of levofloxacin prophylaxis on health outcomes, quality‐adjusted life‐years (QALY), and direct health costs were derived from a combined decision tree and state‐transition model. One‐way deterministic and probabilistic sensitivity analyses were performed to test the sensitivity of results to parameter uncertainty. Results The literature review revealed one randomized controlled trial on levofloxacin prophylaxis in childhood AML and relapsed ALL, by Alexander et al, that showed a significant reduction in rates of fever and neutropenia (71.2% vs 82.1%) and bacteremia (21.9% vs 43.4%) with levofloxacin compared to no prophylaxis. In our cost‐utility analysis, levofloxacin prophylaxis was dominant over no prophylaxis, resulting in cost savings of $542.44 and increased survival of 0.13 QALY. In probabilistic sensitivity analysis, levofloxacin prophylaxis was dominant in 98.8% of iterations. Conclusions The present analysis suggests that levofloxacin prophylaxis, compared to no prophylaxis, is cost saving in children receiving intensive chemotherapy for AML or relapsed ALL.

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Clinical and microbiological impact of discontinuation of fluoroquinolone prophylaxis in patients with prolonged profound neutropenia

Cited by 30 publications

References 24 publications

A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis

A prospective evaluation of ultrasound as a diagnostic tool in acute microcrystalline arthritis

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

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