title: Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: two parallel patient cohorts treated in a single center.
abstract: Patients undergoing intensive chemotherapy for acute myeloid leukemia are at high risk for bacterial infections during therapy-related neutropenia. However, the use of specific antibiotic regimens for prophylaxis in afebrile neutropenic acute myeloid leukemia patients is controversial. We report a retrospective evaluation of 172 acute myeloid leukemia patients who received 322 courses of myelosuppressive chemotherapy and had an expected duration of neutropenia of more than seven days. The patients were allocated to antibiotic prophylaxis groups and treated with colistin or ciprofloxacin through 2 different hematologic services at our hospital, as available. The infection rate was reduced from 88.6% to 74.2% through antibiotic prophylaxis (vs without prophylaxis; P=0.04). A comparison of both antibiotic drugs revealed a trend towards fewer infections associated with ciprofloxacin prophylaxis (69.2% vs 79.5% in the colistin group; P=0.07), as determined by univariate analysis. This result was confirmed through multivariate analysis (OR: 0.475, 95%CI: 0.236-0.958; P=0.041). The prophylactic agents did not differ with regard to the microbiological findings (P=0.6, not significant). Of note, the use of ciprofloxacin was significantly associated with an increased rate of infections with pathogens that are resistant to the antibiotic used for prophylaxis (79.5% vs 9.5% in the colistin group; P<0.0001). The risk factors for higher infection rates were the presence of a central venous catheter (P<0.0001), mucositis grade III/IV (P=0.0039), and induction/relapse courses (vs consolidation; P<0.0001). In conclusion, ciprofloxacin prophylaxis appears to be of particular benefit during induction and relapse chemotherapy for acute myeloid leukemia. To prevent and control drug resistance, it may be safely replaced by colistin during consolidation cycles of acute myeloid leukemia therapy.
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany michele.pohlen@ukmuenster.de.
authors.forename: Michele
authors.initials: M
authors.lastname: Pohlen
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Marx
authors.affiliation: Institute of Hygiene, University Hospital Muenster, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mellmann
authors.affiliation: Institute of Medical Microbiology, University Hospital Muenster, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany.
authors.forename: Rolf M
authors.initials: RM
authors.lastname: Mesters
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany.
authors.forename: Jan-Henrik
authors.initials: JH
authors.lastname: Mikesch
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schliemann
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany Translational Oncology, University Hospital Muenster, Germany Cluster of Excellence EXC 1003, Cells in Motion, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Lenz
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany Department of Medicine IV, Hematology and Oncology, University Hospital Halle, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Müller-Tidow
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Büchner
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany Department of Medicine 3, Klinikum Leverkusen, Germany.
authors.forename: Utz
authors.initials: U
authors.lastname: Krug
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stelljes
authors.affiliation: Institute of Hygiene, University Hospital Muenster, Germany Cluster of Excellence EXC 1003, Cells in Motion, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Karch
authors.affiliation: Institute of Medical Microbiology, University Hospital Muenster, Germany Cluster of Excellence EXC 1003, Cells in Motion, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Peters
authors.affiliation: Department of Medicine D, Nephrology and Rheumatology, University Hospital Muenster, Germany.
authors.forename: Hans U
authors.initials: HU
authors.lastname: Gerth
authors.affiliation: Institute of Biostatistics and Clinical Research, University Muenster, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Görlich
authors.affiliation: Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany Cluster of Excellence EXC 1003, Cells in Motion, Germany.
authors.forename: Wolfgang E
authors.initials: WE
authors.lastname: Berdel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001424:Bacterial Infections / Q000188:drug therapy / Q000517:prevention & control; D062905:Central Venous Catheters / Q000009:adverse effects; D002939:Ciprofloxacin / Q000008:administration & dosage*; D015331:Cohort Studies; D003091:Colistin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000150:complications; D009503:Neutropenia / Q000188:drug therapy / Q000517:prevention & control*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000970:Antineoplastic Agents; D002939:Ciprofloxacin; D003091:Colistin