Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients

• Published in: Bone marrow transplantation (Basingstoke) Vol. 46; no. 9; pp. 1231 - 1239
• Main Authors: Liu, C-Y, Lai, Y-C, Huang, L-J, Yang, Y-W, Chen, T-L, Hsiao, L-T, Liu, J-H, Gau, J-P, Chen, P-M, Tzeng, C-H, Chiou, T-J
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01-09-2011; Nature Publishing Group
• Subjects: 692/420/254; 692/700/1750; 692/700/565/1436/1983; 692/700/565/545/576/1955; Administration, Oral; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics; Antimicrobial resistance; Bacteremia - prevention & control; Bacteria; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cell Biology; Cephalosporins; Cohort Studies; Confidence intervals; Disease prevention; Drug therapy; Female; Gram-negative bacteria; Health aspects; Hematology; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Humans; Infection; Infections; Internal Medicine; Kaplan-Meier Estimate; Levofloxacin; Male; Medical sciences; Medicine; Medicine & Public Health; Mortality; Ofloxacin - therapeutic use; original-article; Patients; Prophylaxis; Public Health; Retrospective Studies; Risk factors; Stem cell transplantation; Stem Cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Treatment Outcome; Young Adult; Taiwan; bloodstream infections; antibiotic prophylaxis; allogeneic hematopoietic SCT; levofloxacin; Levofloxacin; Prognosis; Hematology; Recipient; Infection; Prevention; Fluoroquinolone derivatives; Antibiotic; Allogeneic hematopoietic stem cell transplantation; Antibacterial agent; Therapeutic protocol; Quinolone derivatives
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2010.286

This study aimed to determine the impact of blood stream infections (BSIs) on outcome of allogeneic hematopoietic SCT (HSCT), and to examine the influence of old (non-levofloxacin-containing) and new (levofloxacin-based) prophylactic antibiotic protocols on the pattern of BSIs. We retrospectively enrolled 246 allogeneic HSCT recipients between January 1999 and June 2006, dividing patients into BSI (within 6 months post-HSCT,
n
=61) and non-BSI groups (
n
=185). We found that Gram-negative bacteria (GNB) predominated BSI pathogens (54%). Multivariate analyses showed that patients with a BSI, compared with those without, had a significantly greater 6-month mortality (hazard ratio, 1.75; 95% confidence interval, 1.09–2.82;
P
=0.021) and a significantly increased length of hospital (LOH) stay (70.8 vs 55.2 days,
P
=0.014). Moreover, recipients of old and new protocols did not have a significantly different 6-month mortality and time-to-occurrence of BSIs. However, there were significantly more resistant GNB to third-generation cephalosporins and carbapenem in recipients of levofloxacin-based prophylaxis. Our data suggest that BSIs occur substantially and impact negatively on the outcome and LOH stay after allogeneic HSCT despite antibiotic prophylaxis. Levofloxacin-based prophylaxis, albeit providing similar efficacy to non-levofloxacin-containing regimens, may be associated with increased antimicrobial resistance.