Prevalence of Ciprofloxacin-Resistant Escherichia coli in Hematologic-Oncologic Patients

Baum, Heike von; Franz, Ute; Geiss, H. K.

doi:10.1007/s150100070019

Cited by 37 publications

(20 citation statements)

References 12 publications

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“…Many reports have documented the emergence of bacteria resistant to fluoroquinolones in units in which prophylaxis is practiced (e.g., see Cometta et al, Kern et al, Baum et al, and Razonable et al [24][25][26][27] ). There are no quantitative data indicating the extent to which patients came to harm as a result.…”

Section: Which Patients Should Be Offered Antibiotic Prophylaxis?mentioning

confidence: 99%

Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

177

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New evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. For patients with acute leukemia or those who undergo bone marrow transplantation, prophylaxis with fluoroquinolones diminished the risk of death from any cause by 33% (95% confidence interval [95% CI], 2-54%). Thus, 55 patients who have acute leukemia or who undergo bone marrow transplantation must receive prophylaxis to prevent 1 death. In 4 studies that included patients with solid tumors or lymphoma, prophylaxis reduced the rate of death during the first month (relative risk, 0.51; 95% CI, 0.27-0.97), and 82 patients had to receive prophylaxis to prevent 1 death. The main argument brought against prophylaxis is the induction of resistance. Patients who received prophylaxis did not experience more infections caused by resistant strains than patients in the control group. The recent GIMEMA study was con- N ew evidence shows that antibiotic prophylaxis in neutropenic patients reduces mortality, febrile episodes, and bacterial infections. A systematic review and meta-analysis of randomized controlled trials 1 demonstrated that death from all causes was reduced by 34% (95% confidence interval [95% CI], 21-45%) in neutropenic patients who received any antibiotic prophylaxis and by 40% (95% CI, 17-56%) in patients who received quinolones for prophylaxis. in addition, the occurrence of febrile episodes and bacterial infections decreased significantly (Table 1). Most of the studies that were included in that meta-analysis addressed patients with hematologic malignancies. In the most recent and largest randomized controlled trial that included patients in whom neutropenia was expected to occur for more than 7 days (mainly with acute leukemia and autologous peripheral blood stem cell transplantation), 2 patients who received levofloxacin as prophylaxis had a relative risk (RR) of 0.54 (95% CI, 0.25-1.16) for mortality compared with the placebo group: a Dr. Cullen has received honoraria from Sanofi Aventis.We thank Dr. Vivianne Tjan-Heijnen and Ms. Muriel Debois for supplying us with full data regarding mortality from their study.

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Section: Which Patients Should Be Offered Antibiotic Prophylaxis?mentioning

confidence: 99%

Antibiotic prophylaxis in neutropenic patients

Leibovici

Cullen

Bucaneve³

et al. 2006

Cancer

177

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“…[2][3][4] Despite the logic of reducing bowel and mouth flora with antibiotics, thereby reducing the risk of subsequent bacteremia, there is no consensus that this is the right thing to do. [5][6][7][8] Preliminary work has even suggested that ciprofloxacin without metronidazole given as prophylaxis might promote development of graft-versus-host disease 9 and that ciprofloxacin alone may be associated with an increased risk of leukemia relapse among HSCT recipients. 10 In general, the infectious disease community, citing the concern of promoting drug resistance, has been hesitant about making this a routine approach, while the oncology community, with a specific patient in front of them whom they are trying to keep out of the hospital, has been more enthusiastic.…”

Section: Oral Prophylaxis: Background and Rationalementioning

confidence: 99%

Antibiotic prophylaxis in patients receiving hematopoietic stem cell transplant

Sepkowitz

2002

Bone Marrow Transplant

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Summary:Effective prophylaxis against specific infections has allowed increasingly potent conditioning regimens to be given, thereby prolonging survival in HSCT recipients. The Centers for Disease Control and Prevention, in collaboration with numerous professional societies, has recently published guidelines to codify and advance this approach. Controversy remains in several areas but, curiously, the most intense debate concerns prevention of bacterial infections, the most extensively studied of all of the approaches. Central to this debate are the competing priorities of a potentially ill patient on the one hand vs the long-term consequences of unchecked antibiotic use. The emergence in the 1990s of vancomycin-resistant Enterococcus demonstrated all too vividly how devastating such an end result could be. This article will review the arguments for and against the routine use of antibacterial prophylaxis in HSCT recipients.

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“…However, for both infection control programs and research studies, this approach is often infeasible or impractical. Thus, hospital epidemiologists and researchers often rely on perirectal or rectal swabs to identify patients colonized with resistant organisms (1,2,8). Despite the widespread use of these approaches, no data exist describing their sensitivity and specificity for detection of resistant GNB compared to the gold standard of stool sample.…”

mentioning

confidence: 99%

Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant Escherichia coli in the Gastrointestinal Tract

Lautenbach

Harris

Perencevich

et al. 2005

Antimicrob Agents Chemother

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Among 63 patients enrolled in a prospective cohort study of gut colonization with fluoroquinolone-resistant Escherichia coli, the sensitivity of perirectal swab compared to stool sample was 90% (95% confidence interval [CI], 70 to 99%) and the specificity was 100% (95% CI, 91 to 100%). For rectal swab, the sensitivity was 90% (95% CI, 68 to 99%) and the specificity was 100% (95% CI, 91 to 100%).Resistance to many antimicrobial drugs has increased significantly among gram-negative bacilli (GNB) in recent years (5,6,9,10). GNB colonizing the gastrointestinal (GI) tract serve as both the reservoir for the person-to-person spread of resistant bacteria and the likely source for subsequent clinical infection in colonized individuals (4). Timely and accurate identification of patients with GI tract colonization with resistant GNB is thus critical.Currently, the culture of a stool sample is considered the "gold standard" for identification of GI tract colonization with resistant GNB. However, for both infection control programs and research studies, this approach is often infeasible or impractical. Thus, hospital epidemiologists and researchers often rely on perirectal or rectal swabs to identify patients colonized with resistant organisms (1,2,8). Despite the widespread use of these approaches, no data exist describing their sensitivity and specificity for detection of resistant GNB compared to the gold standard of stool sample.We conducted this study to determine the test characteristics (i.e., sensitivities and specificities) of perirectal and rectal swabs, and we used stool sample as the gold standard. This is the first study to investigate this issue for GNB. We specifically focused on detection of GI tract colonization with fluoroquinolone (FQ)-resistant Escherichia coli (FQREC).The study was performed at two hospitals within the University of Pennsylvania Health System: (i) The Hospital of the University of Pennsylvania, an academic tertiary care medical center with 625 patient beds; and (ii) Presbyterian Medical Center, a 344-bed urban community hospital. This study was reviewed and approved by the Committee on Studies Involving Human Beings of the University of Pennsylvania. We conducted a cross-sectional study of subjects enrolled in an ongoing prospective cohort study. This larger cohort study, in which all hospitalized patients were eligible to participate, investigated the incidence of new GI tract colonization with nosocomial FQREC. Over a 12-month period, all study subjects enrolled in the ongoing cohort study, for which a perirectal swab, rectal swab, and stool sample were collected within the same 24-hour period, were included in our study. A rectal swab was not required for neutropenic subjects; hence, neutropenic subjects were included if a perirectal swab and stool sample were collected within the same 24-hour period. Study subjects known to be FQREC colonized were oversampled to ensure that they accounted for at least 25% of the study cohort. The same research nurse collected perirectal and rectal s...

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Prevalence of Ciprofloxacin-Resistant Escherichia coli in Hematologic-Oncologic Patients

Cited by 37 publications

References 12 publications

Antibiotic prophylaxis in neutropenic patients

Antibiotic prophylaxis in neutropenic patients

Antibiotic prophylaxis in patients receiving hematopoietic stem cell transplant

Test Characteristics of Perirectal and Rectal Swab Compared to Stool Sample for Detection of Fluoroquinolone-Resistant Escherichia coli in the Gastrointestinal Tract

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