title: Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients.
abstract: Although fluoroquinolone prophylaxis is frequently utilized in autologous hematopoietic stem cell transplant (AHSCT) patients, its impact on morbidity and mortality is uncertain. This study investigates the role of quinolone prophylaxis after AHSCT in recent years.
  
  
  
  We conducted a retrospective review of 291 consecutive adult patients who underwent AHSCT for malignant disorders, between June 2013 and January 2015. Outcomes were compared between patients who received norfloxacin prophylaxis and those who did not. The endpoints were mortality during prophylaxis and at 100 days after transplant, frequency of ICU admissions, and incidence and type of bacteremia.
  
  
  
  Of 291 patients, 252 patients received norfloxacin prophylaxis and 39 patients did not. The mortality during prophylaxis and at 100 days as well as the median number of days of hospitalization following AHSCT did not differ between the two groups. No differences were noted in the frequency of ICU admission, incidence of septic shock, and duration of ICU stay. Patients who did not receive prophylaxis had a significantly higher rate of neutropenic fever (97%) than patients who received prophylaxis (77%) (p = 0.005). The patients with prophylaxis demonstrated a significantly higher rate of gram-positive bacteremia as compared to those without prophylaxis (p = 0.002). Frequency of Clostridium difficile infection was similar during and post-prophylaxis. More antibiotic use was noted among patients without prophylaxis [97%; median 9 (range, 5-24) days] compared to patients with prophylaxis [79%; median 7 (range, 3-36) days, p = 0.04].
  
  
  
  Although fluoroquinolone prophylaxis reduced the incidence of neutropenic fever and antibiotic use in AHSCT, it did not alter mortality or morbidity.
authors.affiliation: Department of Hematology-Oncology, Karmanos Cancer Institute/Wayne State University, 4100 John R, HW04H0, Detroit, MI, 48201, USA. modid@karmanos.org.
authors.forename: Dipenkumar
authors.initials: D
authors.lastname: Modi
authors.affiliation: Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA.
authors.forename: Hyejeong
authors.initials: H
authors.lastname: Jang
authors.affiliation: Biostatistics Core, Karmanos Cancer Institute, Department of Oncology, Wayne State University, Detroit, MI, 48201, USA.
authors.forename: Seongho
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, 3990 John R, 5904 5Hudson, Detroit, MI, 48201, USA.
authors.forename: Malini
authors.initials: M
authors.lastname: Surapaneni
authors.affiliation: Wayne State School of Medicine, 320 E Canfield Ave; Suite 315, Detroit, MI, 48201, USA.
authors.forename: Kamya
authors.initials: K
authors.lastname: Sankar
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Deol
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Ayash
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA.
authors.forename: Divaya
authors.initials: D
authors.lastname: Bhutani
authors.affiliation: Division of Hematology/Oncology, University of Virginia Cancer Center, West Complex, Rm 7191, 1300 Jefferson Park Avenue, Charlottesville, VA, USA.
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lum
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA.
authors.forename: Voravit
authors.initials: V
authors.lastname: Ratanatharathorn
authors.affiliation: Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, 4100 John R, WN10SC, Detroit, MI, 48201, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Manasa
authors.affiliation: Clinical Trials Office Bone Marrow Transplant, Karmanos Cancer Institute, 4100 John R, WN10SC, Detroit, MI, 48201, USA.
authors.forename: Kendra
authors.initials: K
authors.lastname: Mellert
authors.affiliation: Division of Infectious Diseases, Wayne State University, Detroit, MI, 48201, USA.
authors.forename: Pranatharthi
authors.initials: P
authors.lastname: Chandrasekar
authors.affiliation: Department of Oncology, Blood and Marrow Stem Cell Transplant Program, Karmanos Cancer Institute/Wayne State University, 4100 John R, 4 HW04H0, Detroit, MI, 48201, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Uberti
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Autologous stem cell transplant; Fluoroquinolone prophylaxis; Infection prophylaxis; Length of stay and ICU admission; Neutropenic fever