Dipenkumar Modi1, Hyejeong Jang2, Seongho Kim2, Malini Surapaneni3, Kamya Sankar4, Abhinav Deol5, Lois Ayash5, Divaya Bhutani5, Lawrence G Lum6, Voravit Ratanatharathorn5, Richard Manasa7, Kendra Mellert7, Pranatharthi Chandrasekar8, Joseph P Uberti5. 1. Department of Hematology-Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA. modid@karmanos.org. 2. Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA. 3. Department of Internal Medicine, 3990 John R, 5904 5Hudson, Detroit, MI, 48201, USA. 4. Wayne State School of Medicine, 320 E Canfield Ave; Suite 315, Detroit, MI, 48201, USA. 5. Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA. 6. Division of Hematology/Oncology, University of Virginia Cancer Center, West Complex, Rm 7191, 1300 Jefferson Park Avenue, Charlottesville, VA, USA. 7. Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, 4100 John R, WN10SC, Detroit, MI, 48201, USA. 8. Division of Infectious Diseases, Wayne State University, Detroit, MI, 48201, USA.
Abstract
PURPOSE: Although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (AHSCT) patients, its impact on morbidity and mortality is uncertain. This study investigates the role of quinolone prophylaxis after AHSCT in recent years. METHODS: We conducted a retrospective review of 291 consecutive adult patients who underwent AHSCT for malignant disorders, between June 2013 and January 2015. Outcomes were compared between patients who received norfloxacin prophylaxis and those who did not. The endpoints were mortality during prophylaxis and at 100 days after transplant, frequency of ICU admissions, and incidence and type of bacteremia. RESULTS: Of 291 patients, 252 patients received norfloxacin prophylaxis and 39 patients did not. The mortality during prophylaxis and at 100 days as well as the median number of days of hospitalization following AHSCT did not differ between the two groups. No differences were noted in the frequency of ICU admission, incidence of septic shock, and duration of ICU stay. Patients who did not receive prophylaxis had a significantly higher rate of neutropenic fever (97%) than patients who received prophylaxis (77%) (p = 0.005). The patients with prophylaxis demonstrated a significantly higher rate of gram-positive bacteremia as compared to those without prophylaxis (p = 0.002). Frequency of Clostridium difficile infection was similar during and post-prophylaxis. More antibiotic use was noted among patients without prophylaxis [97%; median 9 (range, 5-24) days] compared to patients with prophylaxis [79%; median 7 (range, 3-36) days, p = 0.04]. CONCLUSION: Although fluoroquinolone prophylaxis reduced the incidence of neutropenic fever and antibiotic use in AHSCT, it did not alter mortality or morbidity.
PURPOSE: Although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (AHSCT) patients, its impact on morbidity and mortality is uncertain. This study investigates the role of quinolone prophylaxis after AHSCT in recent years. METHODS: We conducted a retrospective review of 291 consecutive adult patients who underwent AHSCT for malignant disorders, between June 2013 and January 2015. Outcomes were compared between patients who received norfloxacin prophylaxis and those who did not. The endpoints were mortality during prophylaxis and at 100 days after transplant, frequency of ICU admissions, and incidence and type of bacteremia. RESULTS: Of 291 patients, 252 patients received norfloxacin prophylaxis and 39 patients did not. The mortality during prophylaxis and at 100 days as well as the median number of days of hospitalization following AHSCT did not differ between the two groups. No differences were noted in the frequency of ICU admission, incidence of septic shock, and duration of ICU stay. Patients who did not receive prophylaxis had a significantly higher rate of neutropenic fever (97%) than patients who received prophylaxis (77%) (p = 0.005). The patients with prophylaxis demonstrated a significantly higher rate of gram-positive bacteremia as compared to those without prophylaxis (p = 0.002). Frequency of Clostridium difficile infection was similar during and post-prophylaxis. More antibiotic use was noted among patients without prophylaxis [97%; median 9 (range, 5-24) days] compared to patients with prophylaxis [79%; median 7 (range, 3-36) days, p = 0.04]. CONCLUSION: Although fluoroquinolone prophylaxis reduced the incidence of neutropenic fever and antibiotic use in AHSCT, it did not alter mortality or morbidity.
Entities:
Keywords:
Autologous stem cell transplant; Fluoroquinolone prophylaxis; Infection prophylaxis; Length of stay and ICU admission; Neutropenic fever
Authors: B S Sohn; D H Yoon; S Kim; K Lee; E H Kang; J S Park; D H Lee; S H Kim; J Huh; C Suh Journal: Eur J Clin Microbiol Infect Dis Date: 2011-12-04 Impact factor: 3.267
Authors: Alison G Freifeld; Eric J Bow; Kent A Sepkowitz; Michael J Boeckh; James I Ito; Craig A Mullen; Issam I Raad; Kenneth V Rolston; Jo-Anne H Young; John R Wingard Journal: Clin Infect Dis Date: 2011-02-15 Impact factor: 9.079
Authors: J E Karp; W G Merz; C Hendricksen; B Laughon; T Redden; B J Bamberger; J G Bartlett; R Saral; P J Burke Journal: Ann Intern Med Date: 1987-01 Impact factor: 25.391
Authors: Annika Y Classen; Larissa Henze; Marie von Lilienfeld-Toal; Georg Maschmeyer; Michael Sandherr; Luisa Durán Graeff; Nael Alakel; Maximilian Christopeit; Stefan W Krause; Karin Mayer; Silke Neumann; Oliver A Cornely; Olaf Penack; Florian Weißinger; Hans-Heinrich Wolf; Jörg Janne Vehreschild Journal: Ann Hematol Date: 2021-04-13 Impact factor: 3.673
Authors: Justin G Horowitz; Gerard W Gawrys; Grace C Lee; Brittney A Ramirez; Carole M Elledge; Paul J Shaughnessy Journal: Transpl Infect Dis Date: 2021-07-30