Increasing Rates of Fluoroquinolone Resistance in Escherichia coli Blood and Urinary Isolates in Stem Cell Transplant and Hematologic Malignancy Populations

Abstract

Fluoroquinolone (FQ) antibiotics have been shown to reduce mortality and the number of febrile episodes when used as prophylaxis during neutropenia. Prior studies suggest that prophylaxis may result in increasing rates of FQ resistance. Fluoroquinolone non-susceptibility trends in Escherichia coli isolated from blood and urine cultures were evaluated over a 16-year period during which prophylaxis was initiated in patients with hematologic malignancies and stem cell transplants. Non-susceptibility rates increased after the introduction of prophylaxis, with yearly non-susceptibility rates rising from 30%–33% to 40%–88% in blood isolates. The high rates of non-susceptibility now observed raise concerns about the continued efficacy of FQ prophylaxis. This concern exists particularly in those patients undergoing stem cell transplants where the total FQ non-susceptibility rates over the study period were 82.3%. Further evaluation of the effect of FQ prophylaxis on antibiotic resistance and its efficacy in the setting of increased rates of resistance is warranted.

Low rates of antibiotic resistance and infectious mortality in a cohort of high-risk hematology patients: A single center, retrospective analysis of blood stream infection

“…A single large RCT, specifically assessing the high-risk hematology patient group, demonstrated fewer fevers with the use of levofloxacin prophylaxis, but without differences in infectious mortality or proven BSI [ 27 ]. The downstream consequences of widespread fluoroquinolone prophylaxis are now becoming evident with some centers reporting near-universal fluoroquinolone-resistant isolates from urine and blood of hematology patients [ 28 ]. Our low mortality highlights the safety of a fluoroquinolone prophylaxis-free approach in a setting where first line therapy is microbiologically inappropriate in 11.6% of patients.…”

<p>Prevalence, Risk Factors And Treatment Of The Most Common Gram-Negative Bacterial Infections In Liver Transplant Recipients: A Review</p>

“…The most frequent antibiotics recommended for the treatment of MDR-GNB 9nclude carbapenems (ie, meropenem), colistin, fosfomycin, tigecycline, aminoglycosides and antipseudomonal beta lactams (Table 1). 15,72…”

“…They concluded that the annual rate of fluoroquinolone non-susceptibility in E. coli increased across the study period 2000-2015 for both blood and urine isolates. 72 As mentioned before, polymyxins are identified as the last-resort treatment MDR Gram-negative bacteria, including E. coli. Regrettably, the spread of polymyxin resistance is on the rise amongst these microorganisms.…”

Rethinking Antimicrobial Prophylaxis in the Transplant Patient in the World of Emerging Resistant Organisms—Where Are We Today?

“…In the 1980s and 1990s, gram-positive organisms caused the majority of infectious bacterial complications; however, in the past decade gram-negative infections have become the predominant infections in many centers [44–46]. Along with this reversal of ratio between gram-positive and gram-negatives, there has been a dramatic increase in multi-drug-resistant bacteria [47•, 48•, 49•, 50•].…”