Characterization of bacterial infections in allogeneic hematopoietic stem cell transplant recipients who received prophylactic levofloxacin with either penicillin or doxycycline.
OBJECTIVE
To describe the effect of a combination prophylactic regimen of levofloxacin, a synthetic chemotherapeutic antibiotic of the fluoroquinolone drug class, with either penicillin or doxycycline on the changing epidemiology of bacterial infections and antimicrobial resistance patterns of isolated organisms in the allogeneic hematopoietic stem cell transplant (HSCT) patient population.


METHODS
We conducted a single-center, retrospective cohort study of all allogeneic HSCT recipients from January 1, 2003, through August 31, 2008, who received prophylactic levofloxacin in combination with penicillin (or with doxycycline in penicillin-allergic patients) from allogeneic stem cell infusion until neutrophil engraftment.


RESULTS
Of the 258 patients who underwent allogeneic HSCT during the study period, 231 received levofloxacin prophylaxis, 76 (33%) of whom developed an infection within 3 months after transplant. Over time, the ratio of gram-positive to gram-negative (GN) infections decreased from 2.11 in 2004, the first year that GN organisms were isolated, to 1.11 in 2008 (P=.20). Emergence of fluoroquinolone-resistant GN bacteria was observed (P=.02), whereas resistance to extended-spectrum beta-lactams did not change over time. Combined vancomycin-resistant enterococci colonization and infection rates increased during the study period (P=.04). Clostridium difficile colitis was uncommon.


CONCLUSIONS
Levofloxacin with penicillin or doxycycline prophylaxis may contribute to the emergence of resistant GN infections in allogeneic HSCT recipients over time. Our findings provide additional support for the current standard of practice of administering empiric monotherapy with an antipseudomonal beta-lactam if these patients develop fever or are suspected to have an infection.
Therriault
Bridgette L
BL
Department of Pharmacy, Mayo clinic, Rochester, MN, USA. bridgettet8@yahoo.com
Wilson
John W
JW
Barreto
Jason N
JN
Estes
Lynn L
LL
D019072:Antibiotic Prophylaxis / Q000379:methods; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D015331:Cohort Studies; D004318:Doxycycline / Q000008:administration & dosage*; D024881:Drug Resistance, Bacterial; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D064704:Levofloxacin; D015242:Ofloxacin / Q000008:administration & dosage*; D010406:Penicillins / Q000008:administration & dosage*; D012189:Retrospective Studies; D014184:Transplantation, Homologous
D010406:Penicillins; D064704:Levofloxacin; D015242:Ofloxacin; D004318:Doxycycline