Ugarte-Torres Alejandra, Villasis-Keever Angelina, Hernández-Bribiesca María Elena, Crespo-Solis Erick, Ruiz-Palacios Guillermo M, Sifuentes-Osornio José, Ponce-De-León-Garduño Alfredo
Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, DF.
Rev Invest Clin. 2006 Nov-Dec;58(6):547-54.
The use of fluoroquinolone prophylaxis in patients with cancer and neutropenia has failed to show a significant impact on mortality, despite its usefulness in reducing the incidence of gramnegative bacteremia. However, an increase in grampositive bacteremia and the emergence of resistant colonizing bacteria have consistently been noticed.
To determine the impact of prophylaxis with fluoroquinolones on the incidence of bacteremia and mortality in a hospital with high fluorquinolone resistance in Mexico City.
We conducted a retrospective and comparative study of patients with acute mieloid (AML) and hybrid (HL) leukemia who received or not prophylaxis with fluoroquinolones and who were attended from January 2000 to December 2003. We reviewed all pertinent clinical and laboratory data of the hematologic malignancies and the febrile episodes.
A total of 108 febrile episodes of severe neutropenia occurred in 69 patients, with an incidence of 6.5 events/1000 day-patient with neutropenia. The median age was 35 +/- 18.3 years and 58% were men; 51 patients had AML (71.8%) and 20 (28.1%) HL. Prophylaxis had been given since the beginning of granulocytopenia in 46 (42.6%) febrile episodes (group 1), where as in 62 no prophylaxis was given (group 2). Of the 46 episodes with prophylaxis, 27 received ciprofloxacin 500 mg qd p.o. and 19, ciprofloxacin 500 mg qd po plus fluconazol 100 mg qd po. The median duration of prophylaxis was 8.5 days (range 1-90 days). Twenty-nine bacteremias (26.8%) were documented, with an incidence of 16.4 bacteremias/1000 day-patient with neutropenia, 12 (26%) in group 1 and 17 (27.5%) in group 2. Bacteremia was most frequently caused by gram negative organisms (18/29), being Escherichia coli (14) the most commonly isolated pathogen, with 7 episodes in each group. Eight (29.6%) of the 21 isolates in which fluoroquinolone susceptibility was tested were ciprofloxacin resistant, 3 in group 1 and 5 in group 2 (p = 0.58). Median survival of patients was 38 days in group 1 and 40 days in group 2. (p = 0.2); mortality was similar in both groups, 34% and 27%, respectively.
In a hospital with a high prevalence of fluoroquinolone-resistance, prophylaxis in patients with acute leukemia and severe neutropenia did not prevent febrile episodes and did not have any impact on mortality. However, there was no increase in infections caused by resistant bacteria.
尽管氟喹诺酮预防性用药在降低革兰氏阴性菌血症发生率方面有用，但在癌症和中性粒细胞减少患者中使用氟喹诺酮预防性用药对死亡率并未显示出显著影响。然而，革兰氏阳性菌血症的增加以及耐药定植菌的出现一直受到关注。
确定在墨西哥城氟喹诺酮耐药率高的医院中，氟喹诺酮预防性用药对菌血症发生率和死亡率的影响。
我们对2000年1月至2003年12月期间接受或未接受氟喹诺酮预防性用药的急性髓系白血病（AML）和混合细胞白血病（HL）患者进行了一项回顾性比较研究。我们回顾了血液系统恶性肿瘤的所有相关临床和实验室数据以及发热性发作情况。
69例患者共发生108次严重中性粒细胞减少的发热性发作，发生率为6.5次事件/1000中性粒细胞减少日患者。中位年龄为35±18.3岁，58%为男性；51例患者患有AML（71.8%），20例（28.1%）患有HL。在46次（42.6%）发热性发作中，从粒细胞减少开始就给予了预防性用药（第1组），而62次未给予预防性用药（第2组）。在46次有预防性用药的发作中，27例接受环丙沙星500mg每日口服一次，19例接受环丙沙星500mg每日口服一次加氟康唑100mg每日口服一次。预防性用药的中位持续时间为8.5天（范围1 - 90天）。记录到29例菌血症（26.8%），发生率为16.4例菌血症/1000中性粒细胞减少日患者，第1组12例（26%），第2组17例（27.5%）。菌血症最常见由革兰氏阴性菌引起（18/29），大肠杆菌（14例）是最常分离出的病原体，每组各7例。在检测氟喹诺酮敏感性的21株分离菌中，8株（29.6%）对环丙沙星耐药，第1组3株，第2组5株（p = 0.58）。第1组患者的中位生存期为38天，第2组为40天（p = 0.2）；两组死亡率相似，分别为34%和27%。
在氟喹诺酮耐药率高的医院中，对急性白血病和严重中性粒细胞减少患者进行预防性用药并不能预防发热性发作，对死亡率也没有任何影响。然而，耐药菌引起的感染并未增加。
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