title: Clinical and microbiological impact of discontinuation of fluoroquinolone prophylaxis in patients with prolonged profound neutropenia.
abstract: BACKGROUND
  Infections remain a leading cause of morbidity and mortality in patients with reduced immunity caused by haematological disease and chemotherapy-induced neutropenia. We evaluated the clinical and microbiological impact of discontinuing fluoroquinolone prophylaxis in these patients.
  
  
  METHODS
  We analysed 154 admissions in three sequential periods of 8 months: long-standing use, discontinuation of prophylaxis and reintroduction of prophylaxis. Clinical endpoints were occurrence of febrile neutropenia, bacteraemia, severe sepsis, septic shock, response to antibiotic therapy, total antibiotic consumption and duration of hospital stay. Microbiological analysis included bacterial isolates from stool and blood cultures and their resistance pattern.
  
  
  RESULTS
  No significant increase in serious infectious complications was seen with the discontinuation of prophylaxis. The overall incidence of bacteraemia did not change, but a higher proportion of bacterial isolates were Gram-negative (22.2% vs. 5.9% & 8.6%; P = 0.030), more often multisusceptible (50% vs. 0%) and less fluoroquinolone resistant (10% vs. 100%). Screening of stools showed a higher prevalence of organisms in the discontinuation period (86.7% vs. 37.3% & 55.2%; P ≤ 0.001), but they were more frequently multisusceptible (53.8% vs. 10.5% & 6.3%; P ≤ 0.001). After discontinuation of prophylaxis, fluoroquinolone resistance decreased rapidly from 73.7 to 7.7%, in association with a significant decrease in extended spectrum beta-lactamase (ESBL)-producing isolates from 42.1 to 10.3%. Resistance figures immediately returned to prediscontinuation values after reinstitution of prophylaxis.
  
  
  CONCLUSIONS
  No clinically relevant short-term drawbacks were observed with the discontinuation of fluoroquinolone prophylaxis in patients with chemotherapy-induced prolonged profound neutropenia, which led to a significant decrease in fluoroquinolone resistance as well as occurrence of ESBL-producing isolates.
authors.affiliation: Department of Haematology, Antwerp University Hospital, Edegem, Belgium.
authors.forename: Anke
authors.initials: A
authors.lastname: Verlinden
authors.forename: Hilde
authors.initials: H
authors.lastname: Jansens
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Ann L
authors.initials: AL
authors.lastname: van de Velde
authors.forename: Wilfried A
authors.initials: WA
authors.lastname: Schroyens
authors.forename: Zwi N
authors.initials: ZN
authors.lastname: Berneman
authors.forename: Alain P
authors.initials: AP
authors.lastname: Gadisseur
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D064147:Febrile Neutropenia / Q000150:complications; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D006801:Humans; D017053:Infection Control; D007239:Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000209:etiology; D012772:Shock, Septic / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D024841:Fluoroquinolones
keywords: antibiotic prophylaxis; antimicrobial resistance; febrile neutropenia