Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, Ohio.
Biol Blood Marrow Transplant. 2020 Aug;26(8):e198-e201. doi: 10.1016/j.bbmt.2020.03.027. Epub 2020 Apr 15.
Prophylaxis with fluoroquinolone (FQ) for patients undergoing autologous stem cell transplantation (ASCT) remains controversial. We performed a retrospective review of patients undergoing ASCT with and without bacterial prophylaxis to compare endpoints of interest. In accordance with institutional policy, patients undergoing ASCT for multiple myeloma routinely receive levofloxacin prophylaxis during their period of neutropenia, whereas patients undergoing the ASCT for lymphoma do not. We retrospectively examined patients with multiple myeloma (MM) or lymphoma undergoing ASCT between July 2015 and July 2018 for evidence of positive blood cultures. A total of 172 patients underwent ASCT for lymphoma and 343 underwent ASCT for MM. The 2 cohorts were similar in terms of baseline characteristics. Almost 20% (35 of 172) of the patients with lymphoma and 5.2% (18 of 342) of those with MM had a bloodstream infection (BSI). BSI occurred an average of 2 days earlier in patients with lymphoma compared with patients with MM (day +5 versus day +7; P = .0003). The 2 cohorts recovered absolute neutrophil count at the same time. Hospital length of stay was 2 days shorter for patients with MM (median, 20 days versus 18 days; P = .01). The majority of the organisms were gram-negative in both cohorts. Of the organisms commonly tested for FQ sensitivity, only 1 of 25 was resistant in the lymphoma cohort, compared with 7 of 9 in the MM cohort (P < .0001), with 4 being multidrug resistant. The odds of developing a BSI were 4.6 times greater in the lymphoma cohort compared with the MM cohort (95% confidence interval [CI], 2.52 to 8.40; P < .0001). In total, 23 of 172 patients with lymphoma (13.4%) and 28 of 342 patients with MM (8.2%) developed Clostridium difficile infection (odds ratio, 1.73; 95% CI, .96 to 3.11; P = .066). Two infection-related deaths occurred in the MM cohort. Our data indicate that FQ prophylaxis reduces the risk of BSI in patients undergoing ASCT but increases the incidence of resistant organisms. We recommend routine antimicrobial prophylaxis in patients undergoing ASCT to reduce the risk of BSI, along with a systematic and regular review of outcomes.
对于接受自体干细胞移植 (ASCT) 的患者，使用氟喹诺酮类药物 (FQ) 预防仍存在争议。我们对接受有和无细菌预防的 ASCT 患者进行了回顾性分析，以比较感兴趣的终点。根据机构政策，接受多发性骨髓瘤 (MM) 或淋巴瘤 ASCT 的患者在中性粒细胞减少期间常规接受左氧氟沙星预防，而接受淋巴瘤 ASCT 的患者则不接受。我们回顾性检查了 2015 年 7 月至 2018 年 7 月期间接受 ASCT 的多发性骨髓瘤或淋巴瘤患者的阳性血培养证据。共有 172 例患者接受了淋巴瘤 ASCT，343 例患者接受了 MM ASCT。两组患者在基线特征方面相似。近 20%（172 例中的 35 例）的淋巴瘤患者和 5.2%（342 例中的 18 例）的 MM 患者发生血流感染（BSI）。与 MM 患者相比，淋巴瘤患者的 BSI 平均提前 2 天发生（第+5 天与第+7 天；P=.0003）。两组患者的中性粒细胞计数恢复时间相同。MM 患者的住院时间缩短了 2 天（中位数，20 天与 18 天；P=.01）。两组患者的主要病原体均为革兰氏阴性菌。在常规进行 FQ 药敏试验的病原体中，仅淋巴瘤组的 1 株为耐药，而 MM 组有 7 株为耐药（P<0.0001），其中 4 株为多药耐药。与 MM 组相比，淋巴瘤组发生 BSI 的几率高 4.6 倍（95%置信区间，2.52 至 8.40；P<0.0001）。共有 172 例淋巴瘤患者中的 23 例（13.4%）和 342 例 MM 患者中的 28 例（8.2%）发生艰难梭菌感染（比值比，1.73；95%置信区间，0.96 至 3.11；P=.066）。MM 组有 2 例与感染相关的死亡。我们的数据表明，FQ 预防可降低 ASCT 患者发生 BSI 的风险，但会增加耐药菌的发生率。我们建议对接受 ASCT 的患者常规进行抗菌预防，以降低 BSI 的风险，并对结果进行系统和定期审查。
