Impact of Prophylactic Levofloxacin on Rates of Bloodstream Infection and Fever in Neutropenic Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation

Michael J. Satlin, Santosh Vardhana, Rosemary Soave, Tsiporah B. Shore, Tomer M. Mark, Samantha E. Jacobs, Thomas J. Walsh, Usama Gergis

Research output: Contribution to journalArticle

Abstract

Few studies have evaluated the role of antibacterial prophylaxis during neutropenia in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation (HSCT). At our center, levofloxacin prophylaxis was initiated in June 2006 in patients with myeloma who were undergoing autologous HSCT. We compared the incidence of bloodstream infection (BSI) and fever and neutropenia (FN) within 30 days of transplantation before (January 2003 to May 2006) and after (June 2006 to April 2010) the initiation of levofloxacin prophylaxis in patients undergoing autologous HSCT for myeloma. We also compared rates of BSI and FN during the same time periods in autologous HSCT recipients with lymphoma who did not receive antibacterial prophylaxis during either time period. After the initiation of levofloxacin prophylaxis, the BSI rate decreased from 41.2% (49 of 119) to 14.7% (23 of 156) and the rate of FN decreased from 91.6% to 60.9% in patients with myeloma (P <.001, for each). In contrast, rates of BSI (43.1% versus 47.3%; P = .50) and FN (98.8% versus 97.1%; P = .63) did not change in patients with lymphoma. Levofloxacin prophylaxis was independently associated with decreased odds of BSI (odds ratio, .27; 95% confidence interval, .14 to .51; P <.001) and FN (odds ratio, .18; 95% confidence interval, .09 to .36; P <.001) in multivariate analysis. Patients with myeloma had a nonsignificant increase in the risk of BSI due to levofloxacin-resistant Enterobacteriaceae (5% versus 1%, P = .08) and Clostridium difficile infection (7% versus 3%, P = .12) after the initiation of levofloxacin prophylaxis but did not have higher rates of BSI due to other resistant bacteria. Levofloxacin prophylaxis is associated with decreased risk of BSI and FN in patients with myeloma undergoing autologous HSCT.

Original languageEnglish (US)
Pages (from-to)1808-1814
Number of pages7
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
Volume21
Issue number10
DOIs
StatePublished - Oct 1 2015
Externally publishedYes

Fingerprint

Levofloxacin
Hematopoietic Stem Cell Transplantation
Multiple Myeloma
Neutropenia
Fever
Infection
Lymphoma
Odds Ratio
Confidence Intervals
Clostridium Infections
Clostridium difficile
Enterobacteriaceae
Multivariate Analysis
Transplantation
Bacteria
Incidence

Keywords

  • Autologous stem cell transplantation
  • Fluoroquinolone prophylaxis
  • Multiple myeloma

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Impact of Prophylactic Levofloxacin on Rates of Bloodstream Infection and Fever in Neutropenic Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation. / Satlin, Michael J.; Vardhana, Santosh; Soave, Rosemary; Shore, Tsiporah B.; Mark, Tomer M.; Jacobs, Samantha E.; Walsh, Thomas J.; Gergis, Usama.

In: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Vol. 21, No. 10, 01.10.2015, p. 1808-1814.

Research output: Contribution to journalArticle

Satlin, Michael J. ; Vardhana, Santosh ; Soave, Rosemary ; Shore, Tsiporah B. ; Mark, Tomer M. ; Jacobs, Samantha E. ; Walsh, Thomas J. ; Gergis, Usama. / Impact of Prophylactic Levofloxacin on Rates of Bloodstream Infection and Fever in Neutropenic Patients with Multiple Myeloma Undergoing Autologous Hematopoietic Stem Cell Transplantation. In: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2015 ; Vol. 21, No. 10. pp. 1808-1814.
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abstract = "Few studies have evaluated the role of antibacterial prophylaxis during neutropenia in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation (HSCT). At our center, levofloxacin prophylaxis was initiated in June 2006 in patients with myeloma who were undergoing autologous HSCT. We compared the incidence of bloodstream infection (BSI) and fever and neutropenia (FN) within 30 days of transplantation before (January 2003 to May 2006) and after (June 2006 to April 2010) the initiation of levofloxacin prophylaxis in patients undergoing autologous HSCT for myeloma. We also compared rates of BSI and FN during the same time periods in autologous HSCT recipients with lymphoma who did not receive antibacterial prophylaxis during either time period. After the initiation of levofloxacin prophylaxis, the BSI rate decreased from 41.2{\%} (49 of 119) to 14.7{\%} (23 of 156) and the rate of FN decreased from 91.6{\%} to 60.9{\%} in patients with myeloma (P <.001, for each). In contrast, rates of BSI (43.1{\%} versus 47.3{\%}; P = .50) and FN (98.8{\%} versus 97.1{\%}; P = .63) did not change in patients with lymphoma. Levofloxacin prophylaxis was independently associated with decreased odds of BSI (odds ratio, .27; 95{\%} confidence interval, .14 to .51; P <.001) and FN (odds ratio, .18; 95{\%} confidence interval, .09 to .36; P <.001) in multivariate analysis. Patients with myeloma had a nonsignificant increase in the risk of BSI due to levofloxacin-resistant Enterobacteriaceae (5{\%} versus 1{\%}, P = .08) and Clostridium difficile infection (7{\%} versus 3{\%}, P = .12) after the initiation of levofloxacin prophylaxis but did not have higher rates of BSI due to other resistant bacteria. Levofloxacin prophylaxis is associated with decreased risk of BSI and FN in patients with myeloma undergoing autologous HSCT.",
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AB - Few studies have evaluated the role of antibacterial prophylaxis during neutropenia in patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation (HSCT). At our center, levofloxacin prophylaxis was initiated in June 2006 in patients with myeloma who were undergoing autologous HSCT. We compared the incidence of bloodstream infection (BSI) and fever and neutropenia (FN) within 30 days of transplantation before (January 2003 to May 2006) and after (June 2006 to April 2010) the initiation of levofloxacin prophylaxis in patients undergoing autologous HSCT for myeloma. We also compared rates of BSI and FN during the same time periods in autologous HSCT recipients with lymphoma who did not receive antibacterial prophylaxis during either time period. After the initiation of levofloxacin prophylaxis, the BSI rate decreased from 41.2% (49 of 119) to 14.7% (23 of 156) and the rate of FN decreased from 91.6% to 60.9% in patients with myeloma (P <.001, for each). In contrast, rates of BSI (43.1% versus 47.3%; P = .50) and FN (98.8% versus 97.1%; P = .63) did not change in patients with lymphoma. Levofloxacin prophylaxis was independently associated with decreased odds of BSI (odds ratio, .27; 95% confidence interval, .14 to .51; P <.001) and FN (odds ratio, .18; 95% confidence interval, .09 to .36; P <.001) in multivariate analysis. Patients with myeloma had a nonsignificant increase in the risk of BSI due to levofloxacin-resistant Enterobacteriaceae (5% versus 1%, P = .08) and Clostridium difficile infection (7% versus 3%, P = .12) after the initiation of levofloxacin prophylaxis but did not have higher rates of BSI due to other resistant bacteria. Levofloxacin prophylaxis is associated with decreased risk of BSI and FN in patients with myeloma undergoing autologous HSCT.

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