Clinical Impact of Fluoroquinolone-Resistant Escherichia coli in the Fecal Flora of Hematological Patients with Neutropenia and Levofloxacin Prophylaxis

Abstract

BackgroundFluoroquinolone prophylaxis in patients with neutropenia and hematological malignancies is said to be effective on febrile netropenia (FN)-related infection and mortality; however, the emergence of antibiotic resistance has become a concern. Ciprofloxacin and levofloxacin prophylaxis are most commonly recommended. A significant increase in the rate of quinolone-resistant Escherichia coli in fecal flora has been reported following ciprofloxacin prophylaxis. The acquisition of quinolone-resistant E. coli after levofloxacin use has not been evaluated.MethodsWe prospectively examined the incidence of quinolone-resistant E. coli isolates recovered from stool cultures before and after levofloxacin prophylaxis in patients with neutropenia from August 2011 to May 2013. Some patients received chemotherapy multiple times.ResultsIn this trial, 68 patients were registered. Levofloxacin-resistant E. coli isolates were detected from 11 and 13 of all patients before and after the prophylaxis, respectively. However, this was not statistically significant (P = 0.65). Multiple prophylaxis for sequential chemotherapy did not induce additional quinolone resistance among E. coli isolates. Interestingly, quinolone-resistant E. coli, most of which were extended-spectrum β-lactamase (ESBL) producers, were already detected in approximately 20% of all patients before the initiation of prophylaxis. FN-related bacteremia developed in 2 patients, accompanied by a good prognosis.ConclusionsLevofloxacin prophylaxis for neutropenia did not result in a significant acquisition of quinolone-resistant E. coli. However, we detected previous colonization of quinolone-resistant E. coli before prophylaxis, which possibly reflects the spread of ESBL. The epidemic spread of resistant E. coli as a local factor may influence strategies toward the use of quinolone prophylaxis.

Association between the rate of fluoroquinolones-resistant gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

“…lead to higher mortality [6]. It is reported that previous colonization of FQR E. coli can lead to the spread of extended-spectrum beta-lactamase (ESBL) after the use of quinolone prophylaxis [5,7]. The high probability of ESBL production by FQR gram-negative bacteria makes antiinfective treatment more difficult.…”

Association between the rate of fluoroquinolones-resistant Gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014

“…Moreover, compared with other phenotypic resistance patterns, FQR E. coli and Klebsiella spp hospital-onset bacteremia had a larger relative impact on mortality 6 . It is reported that previous colonization of FQR E. coli can lead to the spread of extended-spectrum beta-lactamase (ESBL) after the use of quinolone prophylaxis 5,7 . The high probability of ESBL production by FQR gram-negative bacteria makes anti-infective treatment more difficult.…”

Outpatient management without initial assessment for febrile patients undergoing adjuvant chemotherapy for breast cancer

“…One patient in the present study developed a quinolone-resistant E. coli infection and required intravenous antibiotics while hospitalized for ~2 weeks. Quinolone-resistant E. coli infection is rapidly spreading worldwide, with a prevalence in Japan of almost 20% (20). As the outpatient management performed in the present study did not include any initial assessment, accurate assessment should be performed immediately if a febrile patient does not recover after 3 days of oral antibiotic therapy.…”