| Autor: |
Clerici, Daniela, Galli, Laura, Greco, Raffaella, Lugli, Anna P., Erbella, Federico, Ripa, Marco, Din, Chiara Tassan, Nitti, Rosamaria, Giglio, Fabio, Mastaglio, Sara, Lorentino, Francesca, Xue, Elisabetta, Farina, Francesca, Liberatore, Carmine, Poli, Andrea, Carletti, Silvia, Lupo Stanghellini, Maria T., Carrabba, Matteo G., Assanelli, Andrea A., Ruggeri, Annalisa, Bernardi, Massimo, Corti, Consuelo, Peccatori, Jacopo, Mancini, Nicasio, Scarpellini, Paolo, Ciceri, Fabio, Castagna, Antonella, Oltolini, Chiara |
| Zdroj: |
Blood Advances; 20220101, Issue: Preprints |
| Abstrakt: |
Fluoroquinolone prophylaxis’s (FQ-P) usefulness in patients with neutropenia is controversial. In recent decades, Italian epidemiological data has shown worrisome rates of FQ resistance. A single-center cohort study on 136 autologous stem cell transplantations (ASCTs) and 223 allogeneic hematopoietic stem cell transplantations (allo-HSCTs) was performed from January 2018 to December 2020. Piperacillin/tazobactam was the first-line therapy for febrile neutropenia (FN). Since February 2019, FQ-P has been omitted. We evaluated the day +30 posttransplant cumulative incidence function (CIF) of gram-negative bacteria (GNB) pre-engraftment blood-stream infections (PE-BSIs) and any changes in antimicrobial resistance, FN, and infection-related mortality (IRM). In ASCTs, ≥1 FN episode occurred in 74.3% of transplants, without differences among groups (P = .66). CIF of GNB PE-BSI was 10.1%, with a significant difference according to FQ-P (0% [LEVO-group] vs 14.1% [NO-LEVO-group], P = .016). CIF of IRM was 0% in both groups. In allo-HSCTs, ≥1 FN episode occurred in 96.4% of transplants, without differences among groups (P = .72). CIF of GNB PE-BSI was 28%, and it was significantly higher without FQ-P (14.7% [LEVO-group] vs 34.4% [NO-LEVO-group], P = .003). CIF of IRM was 5%, superimposable in both groups (P = .62). Comparing antimicrobial resistance among GNB in the setting of allo-HSCT, in the group without FQ-P, a significantly higher proportion of pathogens was susceptible to piperacillin/tazobactam (71% vs 30%, P = .026), FQ (49% vs 10%, P = .03), and carbapenems (95% vs 50%, P = .001). FQ-P discontinuation increased GNB PE-BSI but did not impact IRM, both in the ASCT and allo-HSCT settings; importantly, it concurred to significantly decrease antimicrobial resistance in GNB. |
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