Craig M, Cumpston A D, Hobbs G R, Devetten M P, Sarwari A R, Ericson S G
Department of Medicine, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV 26506-9162, USA.
Bone Marrow Transplant. 2007 Apr;39(8):477-82. doi: 10.1038/sj.bmt.1705591. Epub 2007 Feb 26.
Febrile neutropenia is an expected complication during treatment of aggressive hematological malignancies and hematopoietic cell transplantation. We conducted a prospective cohort trial to determine the effects and safety of prophylactic fluoroquinolone administration, and rotation of empiric antibiotics for neutropenic fever in this patient population. From March 2002 through 2004, patients were treated with prophylactic levofloxacin during prolonged neutropenia, and a cycling schedule of empiric antibiotic therapy for neutropenic fever was initiated. The rates of bacteremia, resistance and complications were compared to a retrospective cohort of previously treated patients. The rate of gram-negative bacteremia decreased after the initiation of prophylactic levofloxacin (4.7 vs 1.8 episodes/1000 patient days, P<0.05). Gram-positive bacteremia rates remained unchanged, but more isolates of Enterococcus faecium were resistant to vancomycin after the intervention began. Resistance to the antibiotic agents used in the rotation did not emerge. There was no change in mortality during the intervention period. A prophylactic and cycling antibiotic schedule was successfully implemented on a hematological malignancy and hematopoietic cell transplant unit. gram-negative bacteremia was significantly decreased, without emergence of resistance. Concerns with Gram-positive resistance will require further observation.
发热性中性粒细胞减少是侵袭性血液系统恶性肿瘤治疗及造血干细胞移植过程中预期会出现的一种并发症。我们开展了一项前瞻性队列试验，以确定预防性使用氟喹诺酮以及对该患者群体的中性粒细胞减少性发热采用经验性抗生素轮换治疗的效果及安全性。从2002年3月至2004年，患者在长期中性粒细胞减少期间接受预防性左氧氟沙星治疗，并启动了针对中性粒细胞减少性发热的经验性抗生素治疗循环方案。将菌血症、耐药率及并发症发生率与一组接受过治疗的既往患者的回顾性队列进行比较。预防性使用左氧氟沙星后，革兰阴性菌血症发生率下降（4.7例vs 1.8例/1000患者日，P<0.05）。革兰阳性菌血症发生率保持不变，但干预开始后，更多粪肠球菌分离株对万古霉素耐药。在轮换使用的抗生素中未出现耐药情况。干预期间死亡率无变化。在一个血液系统恶性肿瘤及造血干细胞移植病房成功实施了预防性及循环抗生素方案。革兰阴性菌血症显著减少，且未出现耐药情况。对革兰阳性菌耐药问题仍需进一步观察。
