Prophylaxis of early bacterial infections after autologous peripheral blood stem cell transplantation (PBSCT): a matched-pair study comparing oral fluoroquinolones and intravenous piperacillin-tazobactam.
The safety and efficacy of early bacterial prophylaxis with piperacillin-tazobactam were prospectively evaluated in 51 autologous peripheral blood stem cell transplantation (PBSCT) recipients. The results were compared with those obtained in 51 control patients receiving oral fluoroquinolones in a retrospective matched-pair control study. Overall, 76% of the study group and 98% of the control group developed at least one febrile episode during neutropenia (P=0.002). Time from neutropenia to the first febrile episode (FFE) was significantly longer in the study group than in the control group (P=0.04). Once a febrile episode appeared, the duration of fever was significantly longer in cases than in controls (median of 5 and 2 days respectively, P<0.001), and led to a more frequent use of empirical amphotericin B (AmB), not statistically significant (P=0.13). However, the total time of antibiotic administration was significantly greater in the control than in the study group (P=0.05). The duration of AmB treatment shows a trend toward a longer duration in the control than in study group (P=0.2). Overall, 86% of the Gram-positive bacteremia and 85% of the Gram-negative bacteria were susceptible to the tested antibiotics. Our study suggests that a subgroup of patients could benefit from prophylaxis with piperacillin-tazobactam without increasing toxicity or bacterial resistance.
Solano
C
C
Department of Haematology and Medical Oncology, University Clinic Hospital, School of Medicine, University of Valencia, Valencia, Spain. Carlos.Solano@uv.es
Gutierrez
A
A
Martinez
F
F
Gimeno
C
C
Gómez
C
C
Muñoz
I
I
Faus
F
F
Goterris
R
R
Farga
A
A
Navarro
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage; D016470:Bacteremia / Q000209:etiology; D001424:Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005334:Fever; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009503:Neutropenia; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D010878:Piperacillin / Q000008:administration & dosage; D000077725:Piperacillin, Tazobactam Drug Combination; D011292:Premedication; D014182:Transplantation, Autologous
D024841:Fluoroquinolones; D000077725:Piperacillin, Tazobactam Drug Combination; D000666:Amphotericin B; D010397:Penicillanic Acid; D010878:Piperacillin