title: [Levofloxacin prophylaxis in neutropenic patients].
abstract: Fluorquinolone-prophylaxis has proven useful in preventing infections in high risk neutropenic patients. The objective of this study was to describe the clinical, microbiological and therapeutic characteristics, and outcome of patients in the first episode of febrile neutropenia, comparing those who received levofloxacin prophylaxis with those who didn't. It was a prospective observational study that included all the episodes of inpatients with febrile neutropenia (February 1997- November 2014), also including the first episode in a same patient in different hospitalizations. Of 946 episodes here included, 821 presented high risk febrile neutropenia. A total of 264 cases (27.9%) received levofloxacin prophylaxis. This group consisted of a higher proportion of high risk febrile neutropenia (99.2% vs. 82.3%, p = 0.0001) and patients that had received an hematopoietic stem cell transplant (67.8% vs. 29.3%, p = 0.0001) compared to those who didn't receive prophylaxis. Those who received levofloxacin prophylaxis presented a similar frequency of clinically diagnosed but a lower proportion of microbiologically documented infections (28.8% vs. 37.5%, p = 0.012) than those who didn't receive prophylaxis. The episodes of bacteremia that occurred in the first group were more frequently caused by multidrug resistant bacteria (MDRB) (34.5% vs. 17.3%, p = 0.007) and by extended spectrum beta lactamase producing Enterobacteriaceae (19% vs. 3.8%, p = 0.0001). The group that received prophylaxis had a lower proportion of adequate empirical antibiotic treatment (69.7% vs. 83.7%, p = 0.009), with similar outcomes in both groups. We suggest that levofloxacin prophylaxis should be stopped whenever there is a rise in the frequency of MDRB infections in this population.
authors.affiliation: Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina. E-mail: albertocarena@yahoo.com.ar.
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Carena
authors.affiliation: Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Laura
authors.initials: L
authors.lastname: Jorge
authors.affiliation: Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bonvehí
authors.affiliation: Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Elena
authors.initials: E
authors.lastname: Temporiti
authors.affiliation: Sección Bacteriología, Micología y Parasitología, Departamento de Análisis Clínicos, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Mariela S
authors.initials: MS
authors.lastname: Zárate
authors.affiliation: Sección Infectología, Departamento de Medicina Interna, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
authors.forename: Fabián
authors.initials: F
authors.lastname: Herrera
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D016470:Bacteremia / Q000382:microbiology / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000302:isolation & purification; D064147:Febrile Neutropenia / Q000382:microbiology / Q000517:prevention & control*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D064704:Levofloxacin
keywords: leukemia; levofloxacin prophylaxis; neutropenia