The role of prophylactic antimicrobials during autologous stem cell transplantation: a single-center experience

Abstract

The aim of this study was to investigate the efficacy of antibiotic prophylaxis in patients undergoing autologous stem cell transplantation (ASCT) for multiple myeloma and non-Hodgkin lymphoma. Among 232 ASCT cases performed at the Asan Medical Center, 114 cases underwent treatment with ciprofloxacin, fluconazole, and acyclovir (between January 2001 and August 2005), while 118 cases were performed without antimicrobial prophylaxis (between February 2004 and June 2008). The two-rate χ2 test was applied to accommodate the differences in neutropenia duration. The incidence of febrile episodes was 9.8 cases per 100 person-days in the prophylactic group, while it was 16.2 cases in the no-prophylactic group (p<0.001). The rate of unexplained fever was 8.0 cases per 100 person-days in the prophylactic group, while it was 13.8 cases in the no-prophylactic group (p<0.001). The rate of clinically and microbiologically documented infection was 1.7 cases per 100 person-days in the prophylactic group, while it was 2.3 cases in the no-prophylactic group (p=0.404). There were fewer cases of methicillin-susceptible Staphylococcus aureus infection and a greater number of quinolone-resistant Escherichia coli in the prophylactic group compared with the no-prophylactic group (p=0.056 and p=0.040, respectively). The prophylactic antimicrobials reduced the incidence rate of febrile episodes, especially unexplained fever, despite there being no difference in the incidence of documented infection. Resistant microbe infection occurred more frequently in the prophylactic group.

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

“…However, the emergence of bacterial resistance to antibiotics, especially quinolones, has become a concern, and routine prophylactic use remains controversial [5]–[6]. Particularly, the prevalence of a breakthrough infection of quinolone-resistant gram-negative bacteremia, predominantly related to Escherichia coli , has been reported in neutropenic patients receiving quinolone prophylaxis [2], [7]–[12]. Bacteremia is presumed to develop from these quinolone-resistant E. coli strains after gut colonization, which is the result of antibiotic prophylaxis.…”

Advanced POEMS syndrome treated with high-dose melphalan followed by autologous blood stem cell transplantation: a single-center experience

“…High-dose melphalan (200 mg/m 2 ) was used as the conditioning regimen. All patients received standard supportive care, including prophylactic antibiotics during ASCT [12]. …”

A transcriptomic signature predicting septic outcome in patients undergoing autologous stem cell transplantation

“…The saprophytic gram negative bacilli (such as Escherichia coli) are the most common cause of septic shock [4] and chronic immunosuppression exposes to the risk of fungal infection. An antifungal prophylaxis is usually administered [5] but antimicrobial prophylaxis is less often given because its effectiveness is not clearly established and increases the risk of Clostridium difficile diarrhea [6]. Unfortunately, it is not possible to foresee which patients will develop a SIRS and/or sepsis.…”