Does ciprofloxacin prophylaxis during chemotherapy induce intestinal microflora resistance to ceftazidime in children with cancer?

Tunyapanit, Wanutsanun; Chelae, Sureerat; Laoprasopwattana, Kamolwish

doi:10.1016/j.jiac.2017.12.012

Cited by 20 publications

(16 citation statements)

References 21 publications

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“…These findings also support the hypothesis that an increase in breakthrough infections due to organisms resistant to the prophylactic regimen is, at least in part, associated with selection for colonisation with these organisms. 4,[10][11][12]14 These results are similar to findings from another study 17 that compared the effects of trimethoprim and fluoroquinolone prophylaxis on the resistome in adults with haematological malignancies. That study found a larger effect for trimethoprim-sulfamethoxazole than fluoroquinolone, but in our study, almost all participants received trimethoprim-sulfamethoxazole, so no comparison was possible.…”

Section: Discussionsupporting

confidence: 82%

“…9 This concern is supported by the fact that breakthrough infections during prophylaxis are typically resistant to the specific antibiotics used. 4,[10][11][12] An additional concern is that prophylaxis might also select for genes for resistance to other antibiotic classes, because resistance genes might be transmitted together on plasmids or co-exist in highly resistant organisms. [10][11][12][13][14] However, an increase in resistance is not inevitable, because fluoroquinolone prophylaxis might also reduce the use of other broad-spectrum antibiotics for treating fever and infections.…”

Section: Introductionmentioning

confidence: 99%

“…4,[10][11][12] An additional concern is that prophylaxis might also select for genes for resistance to other antibiotic classes, because resistance genes might be transmitted together on plasmids or co-exist in highly resistant organisms. [10][11][12][13][14] However, an increase in resistance is not inevitable, because fluoroquinolone prophylaxis might also reduce the use of other broad-spectrum antibiotics for treating fever and infections. 4,15 The collection of antibiotic resistance genes (ARGs) in the gut flora, the so-called gastrointestinal resistome, serves as a source of antibiotic resistance for bacteria and has been used to determine the potential for resistant infections in high-risk hosts.…”

Section: Introductionmentioning

confidence: 99%

“…no prophylaxis p<0•0001 significantly between timepoints or prophylaxis groups (appendix p 11). 157 discrete ARGs were detected (appendix p[11][12][13][14].Almost all participants received prophylaxis against P jirovecii pneumonia with trimethoprim-sulfa methoxazole throughout therapy(table 1). Prevalence and relative abundance of genes conferring resistance to trimethoprim or sulfamethoxazole significantly increased during induction therapy (estimated mean fold change 5•9, 95% CI 3•6-9•6; p<0•0001; figure 1; appendix pp[15][16].…”

mentioning

confidence: 99%

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Antibiotic prophylaxis and the gastrointestinal resistome in paediatric patients with acute lymphoblastic leukaemia: a cohort study with metagenomic sequencing analysis

et al. 2021

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Background Although antibiotic prophylaxis with levofloxacin can reduce the risk of serious infection in immunocompromised patients, the potential contribution of prophylaxis to antibiotic resistance is a major drawback. We aimed to identify the effects of levofloxacin prophylaxis, given to paediatric patients with acute lymphoblastic leukaemia to prevent infections during induction chemotherapy, on antibiotic resistance in gastrointestinal microbiota after completion of induction and consolidation therapy. Methods This prospective, single-centre (St Jude Children's Research Hospital, Memphis, TN, USA) cohort study included children (≤18 years) receiving therapy for newly diagnosed acute lymphoblastic leukaemia and who received either primary levofloxacin prophylaxis or no antibacterial prophylaxis (aside from Pneumocystis jirovecii prophylaxis with trimethoprim-sulfamethoxazole) and provided at least two stool samples, including one after completion of induction therapy. We used metagenomic sequencing to identify bacterial genes that confer resistance to fluoroquinolones, trimethoprim-sulfamethoxazole, or other antibiotics, and to identify point mutations in bacterial topoisomerases (gyrA, parC) that confer resistance to fluoroquinolones. We then used generalised linear mixed models to compare the prevalence and relative abundance of antibiotic resistance gene groups after completion of induction and consolidation therapy between participants who had received levofloxacin and those who received no prophylaxis.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Antibiotic prophylaxis and the gastrointestinal resistome in paediatric patients with acute lymphoblastic leukaemia: a cohort study with metagenomic sequencing analysis

et al. 2021

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“…Antibiotic prophylaxis in children with newly diagnosed ALL was investigated in 10 of the final studies 11,41,43,48,49,51‐53,56,57 . Patients with AML or relapsed ALL were included in 11 of the final articles 10,12,40,42,45,46,48,50,52,54,55 .…”

Section: Resultsmentioning

confidence: 99%

Levofloxacin prophylaxis in hospitalized children with leukemia: A cost‐utility analysis

Maser

Pelland‐Marcotte

Alexander

et al. 2020

Pediatric Blood & Cancer

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Background Infections are common and are a major cause of morbidity and mortality during treatment of childhood leukemia. We evaluated the cost effectiveness of levofloxacin antibiotic prophylaxis, compared to no prophylaxis, in children receiving chemotherapy for acute myeloid leukemia (AML) or relapsed acute lymphoblastic leukemia (ALL). Procedures A cost‐utility analysis was conducted from the perspective of the single‐payer health care system using a lifetime horizon. A comprehensive literature review identified available evidence for effectiveness, safety, costs of antibiotic prophylaxis in children with leukemia, and health utilities associated with the relevant health states. The effects of levofloxacin prophylaxis on health outcomes, quality‐adjusted life‐years (QALY), and direct health costs were derived from a combined decision tree and state‐transition model. One‐way deterministic and probabilistic sensitivity analyses were performed to test the sensitivity of results to parameter uncertainty. Results The literature review revealed one randomized controlled trial on levofloxacin prophylaxis in childhood AML and relapsed ALL, by Alexander et al, that showed a significant reduction in rates of fever and neutropenia (71.2% vs 82.1%) and bacteremia (21.9% vs 43.4%) with levofloxacin compared to no prophylaxis. In our cost‐utility analysis, levofloxacin prophylaxis was dominant over no prophylaxis, resulting in cost savings of $542.44 and increased survival of 0.13 QALY. In probabilistic sensitivity analysis, levofloxacin prophylaxis was dominant in 98.8% of iterations. Conclusions The present analysis suggests that levofloxacin prophylaxis, compared to no prophylaxis, is cost saving in children receiving intensive chemotherapy for AML or relapsed ALL.

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Considerations and Caveats in Combating ESKAPE Pathogens against Nosocomial Infections

et al. 2019

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ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are among the most common opportunistic pathogens in nosocomial infections. ESKAPE pathogens distinguish themselves from normal ones by developing a high level of antibiotic resistance that involves multiple mechanisms. Contemporary therapeutic strategies which are potential options in combating ESKAPE bacteria need further investigation. Herein, a broad overview of the antimicrobial research on ESKAPE pathogens over the past five years is provided with prospective clinical applications.

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Does ciprofloxacin prophylaxis during chemotherapy induce intestinal microflora resistance to ceftazidime in children with cancer?

Cited by 20 publications

References 21 publications

Antibiotic prophylaxis and the gastrointestinal resistome in paediatric patients with acute lymphoblastic leukaemia: a cohort study with metagenomic sequencing analysis

Antibiotic prophylaxis and the gastrointestinal resistome in paediatric patients with acute lymphoblastic leukaemia: a cohort study with metagenomic sequencing analysis

Levofloxacin prophylaxis in hospitalized children with leukemia: A cost‐utility analysis

Considerations and Caveats in Combating ESKAPE Pathogens against Nosocomial Infections

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