Antibiotic prophylaxis and management of infections in pediatric hematopoietic stem cell transplantation: a survey from the Stem Cell Transplant and the Infectious Disease Working Groups of the AIEOP network

Zama, Daniele; Masetti, Riccardo; Baccelli, Francesco; Leardini, Davide; Muratore, Edoardo; Abram, Nicoletta; Vendemini, Francesca; Biffi, Alessandra; Perruccio, Katia; D’Amico, Maria Rosaria; Faraci, Maura; Tintori, Veronica; Spirito, A; Nigro, Luca Lo; Locatelli, Franco; Luksch, Roberto; Saglio, Francesco; Santoro, Nicola; Soncini, Elena; Zecca, Marco; Ziino, Ottavio; Prete, Arcangelo; Pagliara, Daria; Cesaro, Simone

doi:10.1038/s41409-022-01793-5

Cited by 4 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among these, quinolones have been widely used as prophylactic agents in pediatric patients, mainly due to the observed efficacy in adults [ 47 ]. Other prophylactic regimens have been proposed in the literature; however, quinolones have been more commonly used in current practice [ 9 , 48 ]. Notably, the use of antibiotic PPX may be associated with several drawbacks, such as toxicity or emergence of antibiotic-resistant bacterial strains, and thus a balance between risks and benefits should be considered.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

Leardini

Muratore

Abram

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

The effectiveness of quinolone prophylaxis in high-risk hematological pediatric patients is controversial. A systematic review was performed according to PRISMA guidelines, including studies that involved children and young adults undergoing chemotherapy for acute leukemia or HSCT and that received quinolone prophylaxis compared to no prophylaxis. Meta-analysis was performed on blood-stream infections and neutropenic fever. Data regarding the impact of prophylaxis on overall survival, antibiotic exposure, antibiotic-related adverse effects, antibiotic resistance, Clostridium difficile infections, fungal infections, length of hospitalization, and costs were reviewed in the descriptive analysis. Sixteen studies were included in the qualitative analysis and ten of them met the criteria for quantitative analysis. Quinolone prophylaxis resulted effective in reducing the rate of blood-stream infections and neutropenic fever in pediatric acute leukemia compared to no prophylaxis, but it had not a significant effect in HSCT recipients. Prophylaxis was associated with a higher rate of bacterial resistance to fluoroquinolones, and higher antibiotic exposure.

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

Leardini

Muratore

Abram

et al. 2022

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Antibacterial prophylaxis in allogeneic HCT, starting with or immediately after the conditioning regimen with the aim of covering the neutropenic phase until engraftment, is controversial due to the absence of a significant effect on patient mortality and concerns about bacterial resistance, unwarranted alterations of the intestinal microbiome, and tolerance and safety issues with fluoroquinolones in pediatric patients. 10,[20][21][22][23][24] Although not recommended by international guidelines 9,10 and authoritative consensus statements, 25 prophylaxis is widely used in clinical practice as demonstrated by a survey from Italy 26 and reports from pediatric transplant programs from all over the world. [27][28][29][30] Comparative pediatric data on antibacterial prophylaxis in the allogeneic HCT setting is restricted to levofloxacin in the form of two studies.…”

Section: Discussionmentioning

confidence: 99%

Stopping antibacterial prophylaxis in pediatric allogeneic hematopoietic cell transplantation: An internal audit

Wintjes,

Krämer,

Kolve

et al. 2023

Transplant Infectious Dis

View full text Add to dashboard Cite

BackgroundAntibacterial prophylaxis in children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) is controversial and not recommended by international guidelines. We analyzed relevant posttransplant outcomes following discontinuation of antibacterial prophylaxis at a major European pediatric transplant center.MethodsThe single‐center retrospective audit included all pediatric allogeneic HCT patients (pts) transplanted between 2011 and 2020 before (≤2014) and after (≥2015) stopping routine antibacterial prophylaxis with penicillin, metronidazole, and ciprofloxacin upon start of the conditioning regimen. The primary endpoint was overall survival until the first hospital discharge. Secondary endpoints included the occurrence of fever; bacterial infections; and cumulative days with antibacterial agents until discharge.ResultsA total of 257 HCT procedures were performed in 249 pts (median age: 10 years, range, 0.2–22.5) for leukemia/lymphoma (n = 150) and nonmalignant disorders (n = 107). Of these, 104 procedures were performed before (cohort 1) and 153 after (cohort 2) stopping prophylaxis. Overall survival until discharge was 90.4% in cohort 1 and 96.1% in cohort 2 (p = .06). No differences were observed in the occurrence of fever (92.3 vs. 94.1%; p = .57) and bacterial infections (34.6 vs. 25.5%; p = .11). The median number of days on antibacterial agents was significantly lower in cohort 2 (39 vs. 34; p = .002). Detection rates of resistant organisms were overall low.ConclusionIn this single‐center audit, the stop of routine antibacterial prophylaxis had no effect on the occurrence of fever, bacterial infections, resistant organisms, and GVHD. Overall antibiotic use was significantly reduced, and survival was noninferior to the historical control cohort. image

show abstract

“…β-lactams are frequently used as first line antibiotic therapy for febrile neutropenia in children with cancer [ 56 , 57 ]. Recent ECIL8 guidelines recommend the use of an antipseudomonal non-carbapenem β-lactam/β-lactamase inhibitor combination for clinically stable patients, whereas carbapenems are reserved for clinically unstable conditions [ 58 ].…”

Section: Antibioticsmentioning

confidence: 99%

“…Cephalosporins are broadly used in pediatric patients as well, often as the first line treatment for neutropenic fever [ 57 , 67 ]. Most studies reported a decrease of Enterobacteriacea and an increase of Enterococcus following their administration [ 68 ].…”

Section: Antibioticsmentioning

confidence: 99%

Pharmacomicrobiomics in Pediatric Oncology: The Complex Interplay between Commonly Used Drugs and Gut Microbiome

Leardini¹,

Venturelli

Baccelli³

et al. 2022

IJMS

Self Cite

View full text Add to dashboard Cite

The gut microbiome (GM) has emerged in the last few years as a main character in several diseases. In pediatric oncological patients, GM has a role in promoting the disease, modulating the effectiveness of therapies, and determining the clinical outcomes. The therapeutic course for most pediatric cancer influences the GM due to dietary modifications and several administrated drugs, including chemotherapies, antibiotics and immunosuppressants. Interestingly, increasing evidence is uncovering a role of the GM on drug pharmacokinetics and pharmacodynamics, defining a bidirectional relationship. Indeed, the pediatric setting presents some contrasts with respect to the adult, since the GM undergoes a constant multifactorial evolution during childhood following external stimuli (such as diet modification during weaning). In this review, we aim to summarize the available evidence of pharmacomicrobiomics in pediatric oncology.

show abstract

Antibiotic prophylaxis and management of infections in pediatric hematopoietic stem cell transplantation: a survey from the Stem Cell Transplant and the Infectious Disease Working Groups of the AIEOP network

Cited by 4 publications

References 13 publications

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

Stopping antibacterial prophylaxis in pediatric allogeneic hematopoietic cell transplantation: An internal audit

Pharmacomicrobiomics in Pediatric Oncology: The Complex Interplay between Commonly Used Drugs and Gut Microbiome

Contact Info

Product

Resources

About