title: Impact of peri-transplant vancomycin and fluoroquinolone administration on rates of bacteremia in allogeneic hematopoietic stem cell transplant (HSCT) recipients: a 12-year single institution study.
abstract: BACKGROUND
  We analyzed the effect of peri-transplant prophylaxis on the epidemiology of bacteremia in a 12-year contemporary cohort of allogeneic HSCT recipients at our center.
  
  
  METHODS
  This was an observational study of 1052 consecutive adult HSCT from 2000 to 2011. Formal prophylaxis with vancomycin only, fluoroquinolone (FQ) only, or vancomycin + FQ was implemented in 2006. The cumulative incidence of day 100 bacteremia was compared between the Early Period (2000-2005) and the Recent Period (2006-2011). Predictors for pre-engraftment bacteremia were analyzed with Cox-proportional hazard models in a subcohort of 821 HSCT who received myeloablative or reduced intensity conditioning (MA/RIC).
  
  
  RESULTS
  The incidence of bacteremia decreased in the Recent Period (32% vs 27%; P = 0.002), whereas the rates of resistance in gram-negative rods (GNR) and vancomycin-resistant enterococci (VRE) were similar between the two Periods (P values are not statistically significant.) In multivariate analyses, prophylaxis with vancomycin only or vancomycin + FQ was protective (HR = 0.5; CI = 0.30-0.72) and (HR = 0.3; CI = 0.12-0.52, P < 0.01). Vancomycin or vancomycin + FQ eliminated viridans streptococcal bacteremia (VSB); vancomycin + FQ decreased GNR bacteremia (HR = 0.35; CI = 0.15-0.85).
  
  
  CONCLUSIONS
  Vancomycin-based prophylaxis peri-transplant in MA/RIC HSCT was associated with elimination of VSB and may be considered at centers with high incidence of this infection.
authors.affiliation: Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: Susan K
authors.initials: SK
authors.lastname: Seo
authors.affiliation: Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Kun
authors.initials: K
authors.lastname: Xiao
authors.affiliation: Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Yao-Ting
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Ubonvan
authors.initials: U
authors.lastname: Jongwutiwes
authors.affiliation: Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Dick
authors.initials: D
authors.lastname: Chung
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Molly
authors.initials: M
authors.lastname: Maloy
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
authors.affiliation: Department of Medicine, Adult Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: Ann A
authors.initials: AA
authors.lastname: Jakubowski
authors.affiliation: Department of Medicine, Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY.|Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY.
authors.forename: Genovefa A
authors.initials: GA
authors.lastname: Papanicolaou
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D014640:Vancomycin
keywords: Allogeneic transplant; Bacteremia; Fluoroquinolone prophylaxis; Vancomycin prophylaxis; Viridans streptococci