Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Biol Blood Marrow Transplant. 2019 Aug;25(8):1637-1641. doi: 10.1016/j.bbmt.2019.04.013. Epub 2019 Apr 17.
National guidelines recommend antimicrobial prophylaxis for allogeneic stem cell transplant patients during the pre-engraftment period because of increased infection risk during neutropenia. Fluoroquinolones have demonstrated lower rates of bacteremias and incidence of neutropenic fever, but there is limited evidence in the use of alternative antibacterials such as cefpodoxime. The primary objective of this study is to compare the rates of antibiotic prophylaxis failure between levofloxacin and cefpodoxime in allogeneic stem cell transplant recipients. Secondary objectives include comparing and characterizing number and type of infections, mortality at day 100 post-transplant, and hospitalizations for infectious causes in the first 100 days of transplant. This is a single-center, retrospective chart review of adult patients who received an allogeneic stem cell transplant from matched related and matched unrelated donors and antibacterial prophylaxis with levofloxacin or cefpodoxime from January 1, 2011, to October 1, 2014. A total of 142 patients were evaluated (71 levofloxacin, 71 cefpodoxime). Both levofloxacin and cefpodoxime groups had similar rates of neutropenic fever and antibiotic prophylaxis failure (58% versus 58%, P = NS). There were similar incidences of Clostridioides difficile and Multi-drug resistant (MDR) infections among both levofloxacin and cefpodoxime groups. Rates of infections, hospitalizations, and mortality in the first 100 days were similar among both groups. Cefpodoxime can be used as an alternative to levofloxacin for antibiotic prophylaxis in allogeneic stem cell transplant patients.
国家指南建议在异基因干细胞移植患者的植入前期间进行抗微生物预防，因为中性粒细胞减少症期间感染风险增加。氟喹诺酮类药物已显示出较低的菌血症和中性粒细胞减少性发热发生率，但在使用替代抗菌药物（如头孢泊肟）方面的证据有限。本研究的主要目的是比较左氧氟沙星和头孢泊肟在异基因干细胞移植受者中的抗生素预防失败率。次要目标包括比较和描述感染的数量和类型、移植后 100 天的死亡率以及移植后 100 天内因感染导致的住院治疗。这是一项单中心、回顾性图表研究，纳入了 2011 年 1 月 1 日至 2014 年 10 月 1 日期间接受匹配相关和匹配无关供体异基因干细胞移植且接受左氧氟沙星或头孢泊肟抗菌预防的成年患者。共评估了 142 例患者（71 例左氧氟沙星，71 例头孢泊肟）。左氧氟沙星和头孢泊肟组的中性粒细胞减少性发热和抗生素预防失败率相似（58%对 58%，P=NS）。两组左氧氟沙星和头孢泊肟组的艰难梭菌和多药耐药（MDR）感染发生率相似。两组在移植后 100 天内的感染、住院和死亡率相似。头孢泊肟可作为异基因干细胞移植患者抗生素预防的左氧氟沙星替代药物。
