Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients

Multidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSC...

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Published in:Antibiotics (Basel) 2022-09, Vol.11 (9), p.1269
Main Authors: Guimarães, Thaís, Borges, Igor Carmo, Spadão, Fernanda de Souza, Mariano, Livia, Nascimento, Marina de Mattos, Higashino, Hermes, Rossi, Flavia, Rocha, Vanderson, Costa, Silvia Figueiredo
Format: Article
Language:English
Subjects:
Antibacterial agents
Antibiotic resistance
Antibiotics
Autografts
Bacteria
bacterial resistance
Bivariate analysis
bloodstream infection
Disease prevention
Drug resistance
Drug resistance in microorganisms
fluoroquinolone
Gram-negative bacteria
Gram-positive bacteria
Health aspects
hematopoietic stem cell transplantation
Hematopoietic stem cells
Hypotheses
Infections
Levofloxacin
Lymphoma
Mortality
Multidrug resistance
Neutropenia
Prophylaxis
Regression analysis
Regression models
Stem cell transplantation
Stem cells
Transplantation
Virulence
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Summary:Multidrug-resistant pathogens have emerged worldwide. We have driven the hypothesis that the non-use of fluoroquinolone prophylaxis during neutropenia could reduce antibiotic resistance in Gram-negative bacteria that cause bloodstream infections (BSIs) in hematopoietic stem cell transplantation (HSCT) patients and that this change in resistance pattern could lead to an impact on BSI mortality. This is a quasi-experimental study comparing BSI incidence, resistance patterns of bacteria that cause BSI, and BSI mortality when levofloxacin prophylaxis was routine for neutropenic HSCT patients (2016–2018) to when fluoroquinolone prophylaxis was discontinued in our center (2019). Bivariate comparisons and multivariate logistic regression models were used for analyses. A total of 310 HSCTs (66 (21%) allogeneic and 244 (79%) autologous) were performed during the study period. Sixty (19%) patients had BSIs, 30 in each evaluated period. The discontinuation of levofloxacin prophylaxis was associated with an increase in BSI incidence and a decrease in the resistance rates of causative BSI bacteria and in BSI 30-day mortality. The increase in the rate of resistant bacteria causing BSI and in BSI mortality might outweigh the benefits of a decrease in BSI incidence caused by fluoroquinolone prophylaxis in neutropenic HSCT patients. We suggest that the routine use of fluoroquinolone in this context be revisited.
ISSN:2079-6382
2079-6382
DOI:10.3390/antibiotics11091269