Beejal R Ganti1,2, Bernard L Marini1, Jerod Nagel1, Dale Bixby3, Anthony J Perissinotti4. 1. Department of Pharmacy Services and College of Pharmacy, University of Michigan Health System, 1111 E. Catherine St., Rm 330, Ann Arbor, MI, 48109, USA. 2. Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA. 3. Division of Hematology-Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 4. Department of Pharmacy Services and College of Pharmacy, University of Michigan Health System, 1111 E. Catherine St., Rm 330, Ann Arbor, MI, 48109, USA. ajperis@med.umich.edu.
Abstract
PURPOSE: This study evaluated the impact of antibacterial prophylaxis with levofloxacin in relapsed/refractory acute myeloid leukemia (AML) patients. METHODS: This was a retrospective, single-center, cohort study. Adult patients with relapsed/refractory AML admitted for reinduction chemotherapy between November 1, 2006 and June 15, 2015 were screened for inclusion. A protocol initiating levofloxacin prophylaxis was implemented on December 1, 2013. Patients receiving hypomethylating agents (decitabine/azacitidine) were not administered antibacterial prophylaxis and thus not included in this analysis. Patients receiving broad spectrum antibiotics on day 1 of reinduction chemotherapy or receiving another antibacterial agent for prophylaxis were also excluded. Ninety-seven patients were included in the control group (no prophylaxis), while 48 patients received levofloxacin prophylaxis. Patients in the prophylaxis group received levofloxacin 500 mg once daily on day 1 of chemotherapy and continued until neutrophil recovery (or hospital discharge or death). RESULTS: There was a reduction in the rate of bacteremia in the prophylaxis group (37.5 %) compared to the control group (53.6 %, p = 0.0789), largely due to a reduction in gram-negative bacteremia (2.1 vs. 21.6 % respectively, p = 0.001). No difference was found between prophylaxis and the control groups in the incidence of neutropenic fever, incidence of multidrug resistance, length of hospital or ICU stay, or mortality. CONCLUSIONS: Levofloxacin prophylaxis reduced the rate of infections overall in adult patients with relapsed/refractory AML, without increasing rates of multidrug-resistant organisms.
PURPOSE: This study evaluated the impact of antibacterial prophylaxis with levofloxacin in relapsed/refractory acute myeloid leukemia (AML) patients. METHODS: This was a retrospective, single-center, cohort study. Adult patients with relapsed/refractory AML admitted for reinduction chemotherapy between November 1, 2006 and June 15, 2015 were screened for inclusion. A protocol initiating levofloxacin prophylaxis was implemented on December 1, 2013. Patients receiving hypomethylating agents (decitabine/azacitidine) were not administered antibacterial prophylaxis and thus not included in this analysis. Patients receiving broad spectrum antibiotics on day 1 of reinduction chemotherapy or receiving another antibacterial agent for prophylaxis were also excluded. Ninety-seven patients were included in the control group (no prophylaxis), while 48 patients received levofloxacin prophylaxis. Patients in the prophylaxis group received levofloxacin 500 mg once daily on day 1 of chemotherapy and continued until neutrophil recovery (or hospital discharge or death). RESULTS: There was a reduction in the rate of bacteremia in the prophylaxis group (37.5 %) compared to the control group (53.6 %, p = 0.0789), largely due to a reduction in gram-negative bacteremia (2.1 vs. 21.6 % respectively, p = 0.001). No difference was found between prophylaxis and the control groups in the incidence of neutropenic fever, incidence of multidrug resistance, length of hospital or ICU stay, or mortality. CONCLUSIONS:Levofloxacin prophylaxis reduced the rate of infections overall in adult patients with relapsed/refractory AML, without increasing rates of multidrug-resistant organisms.
Authors: Paul A Harris; Robert Taylor; Robert Thielke; Jonathon Payne; Nathaniel Gonzalez; Jose G Conde Journal: J Biomed Inform Date: 2008-09-30 Impact factor: 6.317
Authors: Anke Verlinden; Hilde Jansens; Herman Goossens; Ann L van de Velde; Wilfried A Schroyens; Zwi N Berneman; Alain P Gadisseur Journal: Eur J Haematol Date: 2014-05-16 Impact factor: 2.997
Authors: Wolfgang Schuette; Sylke Nagel; Ludwig Fischer von Weikersthal; Stefan Pabst; Christian Schumann; Burkhard Deuss; Thorsten Salm; Katrin Roscher; Nicolas Dickgreber Journal: J Thorac Oncol Date: 2011-12 Impact factor: 15.609
Authors: Michael Cullen; Neil Steven; Lucinda Billingham; Claire Gaunt; Mark Hastings; Peter Simmonds; Nicholas Stuart; Daniel Rea; Mark Bower; Indrajit Fernando; Robert Huddart; Simon Gollins; Andrew Stanley Journal: N Engl J Med Date: 2005-09-08 Impact factor: 91.245