Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019, 163(2):161-165 | DOI: 10.5507/bp.2018.047

Ciprofloxacin prophylaxis during autologous stem cell transplantation for multiple myeloma in patients with a high rate of fluoroquinolone-resistant gram-negative bacteria colonization

Alzbeta Zavrelovaa, Pavla Paterovab, Filip Gabaleca, Pavel Zaka, Jakub Radochaa
a 4 th Department of Internal Medicine - Haematology, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic
b Institute of Clinical Microbiology, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic

Background: Ciprofloxacin prophylaxis used to be a standard precaution during autologous stem cell transplantation. Its benefit, with a high prevalence of fluoroqinolone resistance in the population, has recently been under scrutiny.

Objective: To evaluate the impact of cessation of ciprofloxacin prophylaxis during stem cell transplantation for multiple myeloma.

Patients and Methods: Data from 104 patients with multiple myeloma transplanted during the period from January 2013 to April 2015 were retrospectively reviewed. 67 received standard ciprofloxacin prophylaxis (group A) and 37 received no antibacterial prophylaxis (group B).

Results: Febrile episodes during neutropenia, bloodstream infection (BSI) and mortality in these two cohorts were evaluated. Gram negative BSI was assessed for the colonization of quinolone-resistant gram-negative pathogens. Secondary Clostridium difficile enterocolitis presence was determined in both cohorts. There were 42 (63%), 7 (10%), and 0 febrile episodes, BSI and gram-negative BSI respectively in group A, and 34 (92%), 12 (32%), and 4 (11%) respectively in group B. The differences in the number of febrile episodes (P=0.0011) and deaths (P=0.0427) were statistically significance. Mortality was 0 and 3 (8%) in group A and group B, respectively. There was no significant difference in colonization with quinolone-resistant gram negative pathogens (25 (37%) versus 11 (30%)) between groups. The occurrence of Clostridium difficile colitis was the same in both groups.

Conclusion: We resumed ciprofloxacin prophylaxis for the following reasons. There was a significant reduction in febrile episodes, and consequently a sparing effect of antibiotics used for treatment of this condition. No difference in Clostridium difficile colitis occurred and the mortality rate of 8% in group B was unacceptably high.

Keywords: neutropenia, autologous transplantation, multiple myeloma, ciprofloxacin prophylaxis

Received: March 28, 2018; Accepted: August 16, 2018; Prepublished online: September 7, 2018; Published: June 25, 2019  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Zavrelova, A., Paterova, P., Gabalec, F., Zak, P., & Radocha, J. (2019). Ciprofloxacin prophylaxis during autologous stem cell transplantation for multiple myeloma in patients with a high rate of fluoroquinolone-resistant gram-negative bacteria colonization. Biomedical papers, 163(2), 161-165. doi: 10.5507/bp.2018.047
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Flowers CR, Seidenfeld J, Bow EJ, Karten C, Gleason C, Hawley DK, Kuderer NM, Langston AA, Marr KA, Rolston KV, Ramsey SD. Antimicrobial prophylaxis and outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 2013;31(6):794-810. Go to original source... Go to PubMed...
    2. Bow EJ. Point: fluoroquinolone-based antibacterial chemoprophylaxis in neutropenic cancer patients works for defined outcomes in defined populations, but must be used wisely. J Natl Compr Cancer Netw 2004;2(5):433-44. Go to original source... Go to PubMed...
    3. Hong J, Moon SM, Ahn HK, Sym SJ, Park YS, Park J, Cho YK, Cho EK, Shin DB, Lee JH. Comparison of characteristics of bacterial bloodstream infection between adult patients with allogeneic and autologous hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2013;19(6):994-9. Go to original source... Go to PubMed...
    4. Hamadah A, Schreiber Y, Toye B, McDiarmid S, Huebsch L, Bredeson C, Tay J. The use of intravenous antibiotics at the onset of neutropenia in patients receiving outpatient-based hematopoietic stem cell transplants. PloS One 2012;7(9):e46220. Go to original source... Go to PubMed...
    5. Saito T, Yoshioka S, Iinuma Y, Takakura S, Fujihara N, Ichinohe T, Ishikawa T, Uchiyama T, Ichiyama S. Effects on spectrum and susceptibility patterns of isolates causing bloodstream infection by restriction of fluoroquinolone prophylaxis in a hematology-oncology unit. Eur J Clin Microbiol Infect Dis 2008;27(3):209-16. Go to original source... Go to PubMed...
    6. Kern WV, Klose K, Jellen-Ritter AS, Oethinger M, Bohnert J, Kern P, Reuter S, von Baum H, Marre R. Fluoroquinolone resistance of Escherichia coli at a cancer center: epidemiologic evolution and effects of discontinuing prophylactic fluoroquinolone use in neutropenic patients with leukemia. Eur J Clin Microbiol Infect Dis 2005;24(2):111-8. Go to original source... Go to PubMed...
    7. Bucaneve G, Micozzi A, Menichetti F, Martino P, Dionisi MS, Martinelli G, Allione B, D'Antonio D, Buelli M, Nosari AM, Cilloni D, Zuffa E, Cantaffa R, Specchia G, Amadori S, Fabbiano F, Deliliers GL, Lauria F, Foà R, Del Favero A; Gruppo Italiano Malattie Ematologiche dell'Adulto (GIMEMA) Infection Program. Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia. N Engl J Med 2005;353(10):977-87. Go to original source... Go to PubMed...
    8. Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Ann Intern Med 2005;142(12):979-95. Go to original source... Go to PubMed...
    9. Reuter S, Kern WV, Sigge A, Döhner H, Marre R, Kern P, von Baum H. Impact of fluoroquinolone prophylaxis on reduced infection-related mortality among patients with neutropenia and hematologic malignancies. Clin Infect Dis 2005;40(8):1087-93. Go to original source... Go to PubMed...
    10. Mikulska M, Viscoli C, Orasch C, Livermore DM, Averbuch D, Cordonnier C, Akova M7; Fourth European Conference on Infections in Leukemia Group (ECIL-4), a joint venture of EBMT, EORTC, ICHS, ELN and ESGICH/ESCMID. Aetiology and resistance in bacteraemias among adult and paediatric haematology and cancer patients. J Infect 2014;68(4):321-31. Go to original source... Go to PubMed...
    11. Trecarichi EM, Tumbarello M. Antimicrobial-resistant Gram-negative bacteria in febrile neutropenic patients with cancer: current epidemiology and clinical impact. Curr Opin Infect Dis 2014;27(2):200-10. Go to original source... Go to PubMed...
    12. Montassier E, Batard E, Gastinne T, Potel G, de La Cochetière MF. Recent changes in bacteremia in patients with cancer: a systematic review of epidemiology and antibiotic resistance. Eur J Clin Microbiol Infect Dis 2013;32(7):841-50. Go to original source... Go to PubMed...
    13. Schelenz S, Nwaka D, Hunter PR. Longitudinal surveillance of bacteraemia in haematology and oncology patients at a UK cancer centre and the impact of ciprofloxacin use on antimicrobial resistance. J Antimicrob Chemother 2013;68(6):1431-8. Go to original source... Go to PubMed...
    14. Ng ES-T, Liew Y, Earnest A, Koh LP, Lim S-W, Hsu LY. Audit of fluoroquinolone prophylaxis against chemotherapy-induced febrile neutropenia in a hospital with highly prevalent fluoroquinolone resistance. Leuk Lymphoma 2011;52(1):131-3. Go to original source... Go to PubMed...
    15. Bow EJ. Fluoroquinolones, antimicrobial resistance and neutropenic cancer patients. Curr Opin Infect Dis 2011;24(6):545-53. Go to original source... Go to PubMed...
    16. Kjellander C, Björkholm M, Cherif H, Kalin M, Giske CG. Hematological: Low all-cause mortality and low occurrence of antimicrobial resistance in hematological patients with bacteremia receiving no antibacterial prophylaxis: a single-center study. Eur J Haematol 2012;88(5):422-30. Go to original source... Go to PubMed...
    17. Gudiol C, Bodro M, Simonetti A, Tubau F, González-Barca E, Cisnal M, Domingo-Domenech E, Jiménez L, Carratalà J. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect 2013;19(5):474-9. Go to original source... Go to PubMed...
    18. Gomez L, Garau J, Estrada C, Marquez M, Dalmau D, Xercavins M, Martí JM, Estany C. Ciprofloxacin prophylaxis in patients with acute leukemia and granulocytopenia in an area with a high prevalence of ciprofloxacin-resistant Escherichia coli. Cancer 2003;97(2):419-24. Go to original source... Go to PubMed...
    19. Liss BJ, Vehreschild JJ, Cornely OA, Hallek M, Fätkenheuer G, Wisplinghoff H, Seifert H, Vehreschild MJ. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection 2012;40(6):613-9. Go to original source... Go to PubMed...
    20. Garnica M, Maiolino A, Nucci M. Factors associated with bacteremia due to multidrug-resistant Gram-negative bacilli in hematopoietic stem cell transplant recipients. Braz J Med Biol Res 2009;42(3):289-93. Go to original source... Go to PubMed...
    21. McCusker ME, Harris AD, Perencevich EN, Roghmann MC. Fluoroquinolone Use and Clostridium difficile-Associated Diarrhea. Emerg Infect Dis 2003; 9(6):730-3. Go to original source...
    22. Simondsen KA, Reed MP, Mably MS, Zhang Y, Longo WL. Retrospective analysis of fluoroquinolone prophylaxis in patients undergoing allogeneic hematopoietic stem cell transplantation. J Oncol Pharm Pract 2013;19(4):291-7. Go to original source... Go to PubMed...
    23. Gertz MA, Ansell SM, Dingli D, Dispenzieri A, Buadi FK, Elliott MA, Gastineau DA, Hayman SR, Hogan WJ, Inwards DJ, Johnston PB, Kumar S, Lacy MQ, Leung N, Micallef IN, Porrata LF, Schafer BA, Wolf RC, Litzow MR. Autologous stem cell transplant in 716 patients with multiple myeloma: low treatment-related mortality, feasibility of outpatient transplant, and effect of a multidisciplinary quality initiative. Mayo Clin Proc 2008;83(10):1131-8. Go to original source... Go to PubMed...
    24. Papanikolaou X, Maltezas D, Repousis P, Athanassopoulos A, Alexia S, Megalakaki K, Kotsopoulou M, Mitsouli-Mentzikof C. High dose chemotherapy and autologous stem cell transplantation in patients with multiple myeloma: the experience of a single haematological unit. J BUON 2008;13(2):193-7. Go to PubMed...

    This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.


    Return to the content