Zavrelova Alzbeta, Paterova Pavla, Gabalec Filip, Zak Pavel, Radocha Jakub
4 th Department of Internal Medicine - Haematology, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic.
Institute of Clinical Microbiology, University Hospital Hradec Kralove, Charles University in Prague, Hradec Kralove, Czech Republic Corresponding author: Jakub Radocha, e-mail.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2019 Jun;163(2):161-165. doi: 10.5507/bp.2018.047. Epub 2018 Sep 7.
Ciprofloxacin prophylaxis used to be a standard precaution during autologous stem cell transplantation. Its benefit, with a high prevalence of fluoroqinolone resistance in the population, has recently been under scrutiny.
To evaluate the impact of cessation of ciprofloxacin prophylaxis during stem cell transplantation for multiple myeloma.
Data from 104 patients with multiple myeloma transplanted during the period from January 2013 to April 2015 were retrospectively reviewed. 67 received standard ciprofloxacin prophylaxis (group A) and 37 received no antibacterial prophylaxis (group B).
Febrile episodes during neutropenia, bloodstream infection (BSI) and mortality in these two cohorts were evaluated. Gram negative BSI was assessed for the colonization of quinolone-resistant gram-negative pathogens. Secondary Clostridium difficile enterocolitis presence was determined in both cohorts. There were 42 (63%), 7 (10%), and 0 febrile episodes, BSI and gram-negative BSI respectively in group A, and 34 (92%), 12 (32%), and 4 (11%) respectively in group B. The differences in the number of febrile episodes (P=0.0011) and deaths (P=0.0427) were statistically significance. Mortality was 0 and 3 (8%) in group A and group B, respectively. There was no significant difference in colonization with quinolone-resistant gram negative pathogens (25 (37%) versus 11 (30%)) between groups. The occurrence of Clostridium difficile colitis was the same in both groups.
We resumed ciprofloxacin prophylaxis for the following reasons. There was a significant reduction in febrile episodes, and consequently a sparing effect of antibiotics used for treatment of this condition. No difference in Clostridium difficile colitis occurred and the mortality rate of 8% in group B was unacceptably high.
环丙沙星预防用药曾是自体干细胞移植期间的标准预防措施。鉴于人群中氟喹诺酮耐药性的高流行率，其益处最近受到了审查。
评估多发性骨髓瘤干细胞移植期间停止环丙沙星预防用药的影响。
回顾性分析了2013年1月至2015年4月期间接受移植的104例多发性骨髓瘤患者的数据。67例接受标准环丙沙星预防用药（A组），37例未接受抗菌药物预防用药（B组）。
评估了这两组患者中性粒细胞减少期间的发热发作、血流感染（BSI）和死亡率。对革兰阴性菌血流感染进行了喹诺酮耐药革兰阴性病原体定植情况的评估。确定了两组患者继发性艰难梭菌肠炎的存在情况。A组分别有42例（63%）、7例（10%）和0例发热发作、血流感染和革兰阴性菌血流感染，B组分别有34例（92%）、12例（32%）和4例（11%）。发热发作次数（P=0.0011）和死亡人数（P=0.0427）的差异具有统计学意义。A组和B组的死亡率分别为0和3例（8%）。两组间喹诺酮耐药革兰阴性病原体定植情况无显著差异（25例（37%）对11例（30%））。两组艰难梭菌结肠炎的发生率相同。
我们基于以下原因恢复了环丙沙星预防用药。发热发作次数显著减少，因此用于治疗该病症的抗生素有节省效应。艰难梭菌结肠炎的发生率无差异，且B组8%的死亡率高得令人无法接受。
