Colonization With Fluoroquinolone-Resistant Enterobacterales Decreases the Effectiveness of Fluoroquinolone Prophylaxis in Hematopoietic Cell Transplant Recipients
| Autor: | Rianna Malherbe, Michael Hovan, Stephen G. Jenkins, Koen van Besien, Lars F. Westblade, Jingmei Hsu, Alexandra Gomez-Arteaga, Thomas J. Walsh, Claire Douglass, Catherine B. Small, Michael J. Satlin, Sebastian Mayer, Rosemary Soave, Adrienne A. Phillips, Marisa La Spina, Emily Davidson, Liang Chen, Barry N. Kreiswirth |
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| Rok vydání: | 2021 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty medicine.medical_treatment 030106 microbiology Bacteremia Levofloxacin Hematopoietic stem cell transplantation Neutropenia 03 medical and health sciences 0302 clinical medicine Ciprofloxacin Neoplasms Internal medicine Enterobacterales medicine Humans Colonization 030212 general & internal medicine Retrospective Studies Hematopoietic cell business.industry Broth microdilution Hematopoietic Stem Cell Transplantation Antibiotic Prophylaxis medicine.disease Transplant Recipients Anti-Bacterial Agents Transplantation Major Articles and Commentaries Infectious Diseases business Fluoroquinolones medicine.drug |
| Zdroj: | Clin Infect Dis |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background Levofloxacin prophylaxis is recommended to prevent gram-negative bloodstream infections (BSIs) in patients with prolonged chemotherapy-induced neutropenia. However, increasing fluoroquinolone resistance may decrease the effectiveness of this approach. Methods We assessed the prevalence of colonization with fluoroquinolone-resistant Enterobacterales (FQRE) among patients admitted for hematopoietic cell transplantation (HCT) from November 2016 to August 2019 and compared the risk of gram-negative BSI between FQRE-colonized and noncolonized patients. All patients received levofloxacin prophylaxis during neutropenia. Stool samples were collected upon admission for HCT and weekly thereafter until recovery from neutropenia, and underwent selective culture for FQRE. All isolates were identified and underwent antimicrobial susceptibility testing by broth microdilution. FQRE isolates also underwent whole-genome sequencing. Results Fifty-four of 234 (23%) patients were colonized with FQRE prior to HCT, including 30 of 119 (25%) allogeneic and 24 of 115 (21%) autologous HCT recipients. Recent antibacterial use was associated with FQRE colonization (P = .048). Ninety-one percent of colonizing FQRE isolates were Escherichia coli and 29% produced extended-spectrum β-lactamases. Seventeen (31%) FQRE-colonized patients developed gram-negative BSI despite levofloxacin prophylaxis, compared to only 2 of 180 (1.1%) patients who were not colonized with FQRE on admission (P Conclusions Nearly one-third of HCT recipients with pretransplant FQRE colonization developed gram-negative BSI while receiving levofloxacin prophylaxis, and infections were typically caused by their colonizing strains. In contrast, levofloxacin prophylaxis was highly effective in patients not initially colonized with FQRE. |
| Databáze: | OpenAIRE |
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