title: Impact of Prophylactic Levofloxacin on Rates of Bloodstream Infection and Fever in Neutropenic Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation.
abstract: Few studies have evaluated the role of antibacterial prophylaxis during neutropenia in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation (HSCT). At our center, levofloxacin prophylaxis was initiated in June 2006 in patients with myeloma who were undergoing autologous HSCT. We compared the incidence of bloodstream infection (BSI) and fever and neutropenia (FN) within 30 days of transplantation before (January 2003 to May 2006) and after (June 2006 to April 2010) the initiation of levofloxacin prophylaxis in patients undergoing autologous HSCT for myeloma. We also compared rates of BSI and FN during the same time periods in autologous HSCT recipients with lymphoma who did not receive antibacterial prophylaxis during either time period. After the initiation of levofloxacin prophylaxis, the BSI rate decreased from 41.2% (49 of 119) to 14.7% (23 of 156) and the rate of FN decreased from 91.6% to 60.9% in patients with myeloma (P < .001, for each). In contrast, rates of BSI (43.1% versus 47.3%; P = .50) and FN (98.8% versus 97.1%; P = .63) did not change in patients with lymphoma. Levofloxacin prophylaxis was independently associated with decreased odds of BSI (odds ratio, .27; 95% confidence interval, .14 to .51; P < .001) and FN (odds ratio, .18; 95% confidence interval, .09 to .36; P < .001) in multivariate analysis. Patients with myeloma had a nonsignificant increase in the risk of BSI due to levofloxacin-resistant Enterobacteriaceae (5% versus 1%, P = .08) and Clostridium difficile infection (7% versus 3%, P = .12) after the initiation of levofloxacin prophylaxis but did not have higher rates of BSI due to other resistant bacteria. Levofloxacin prophylaxis is associated with decreased risk of BSI and FN in patients with myeloma undergoing autologous HSCT.
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York. Electronic address: mjs9012@med.cornell.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Satlin
authors.affiliation: Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Santosh
authors.initials: S
authors.lastname: Vardhana
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Soave
authors.affiliation: New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York; Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, New York.
authors.forename: Tsiporah B
authors.initials: TB
authors.lastname: Shore
authors.affiliation: New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York; Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, New York.
authors.forename: Tomer M
authors.initials: TM
authors.lastname: Mark
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.
authors.forename: Samantha E
authors.initials: SE
authors.lastname: Jacobs
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York; New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
authors.affiliation: New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York; Division of Hematology and Medical Oncology, Weill Cornell Medical College, New York, New York.
authors.forename: Usama
authors.initials: U
authors.lastname: Gergis
mesh_terms: D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology; D003131:Combined Modality Therapy; D004352:Drug Resistance, Microbial; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000209:etiology; D064147:Febrile Neutropenia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D000069585:Filgrastim / Q000627:therapeutic use; D019983:Guideline Adherence; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D064704:Levofloxacin / Q000008:administration & dosage / Q000627:therapeutic use*; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
chemical_list: D000935:Antifungal Agents; D064704:Levofloxacin; D000069585:Filgrastim; D008558:Melphalan
keywords: Autologous stem cell transplantation; Fluoroquinolone prophylaxis; Multiple myeloma