Hematology and Bone Marrow Transplantation, San Raffaele Scientific Institute, Milan, Italy.
Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy.
Blood Adv. 2023 May 9;7(9):1621-1634. doi: 10.1182/bloodadvances.2022008226.
Fluoroquinolone prophylaxis's (FQ-P) usefulness in patients with neutropenia is controversial. In recent decades, Italian epidemiological data has shown worrisome rates of FQ resistance. A single-center cohort study on 136 autologous stem cell transplantations (ASCTs) and 223 allogeneic hematopoietic stem cell transplantations (allo-HSCTs) was performed from January 2018 to December 2020. Piperacillin/tazobactam was the first-line therapy for febrile neutropenia (FN). Since February 2019, FQ-P has been omitted. We evaluated the day +30 posttransplant cumulative incidence function (CIF) of gram-negative bacteria pre-engraftment bloodstream infections (PE-BSIs) and any changes in antimicrobial resistance, FN, and infection-related mortality (IRM). In ASCTs, ≥1 FN episode occurred in 74.3% of transplants, without differences among groups (P = .66). CIF of gram-negative bacteria PE-BSI was 10.1%, with a significant difference according to FQ-P (0% [LEVO-group] vs 14.1% [NO-LEVO-group], P = .016). CIF of IRM was 0% in both groups. In allo-HSCTs, ≥1 FN episode occurred in 96.4% of transplants, without differences among groups (P = .72). CIF of gram-negative bacteria PE-BSI was 28%, significantly higher without FQ-P (14.7% [LEVO-group] vs 34.4% [NO-LEVO-group], P = .003). CIF of IRM was 5%, superimposable in both groups (P = .62). Comparing antimicrobial resistance among gram-negative bacteria of allo-HSCT setting, in the group without FQ-P, a significantly higher proportion of pathogens was susceptible to piperacillin/tazobactam (71% vs 30%, P = .026), FQ (49% vs 10%, P = .03), and carbapenems (95% vs 50%, P = .001). FQ-P discontinuation increased gram-negative bacteria PE-BSI but did not impact IRM, both in the ASCT and allo-HSCT settings; importantly, it concurred to significantly decrease antimicrobial resistance in gram-negative bacteria.
氟喹诺酮类预防（FQ-P）在中性粒细胞减少症患者中的作用存在争议。近几十年来，意大利的流行病学数据显示，氟喹诺酮类耐药率令人担忧。一项针对 136 例自体干细胞移植（ASCT）和 223 例异基因造血干细胞移植（allo-HSCT）的单中心队列研究于 2018 年 1 月至 2020 年 12 月进行。哌拉西林/他唑巴坦是发热性中性粒细胞减少症（FN）的一线治疗药物。自 2019 年 2 月以来，已停止使用 FQ-P。我们评估了移植后第 30 天的革兰氏阴性菌定植前血流感染（PE-BSI）累积发生率（CIF）以及抗菌药物耐药性、FN 和感染相关死亡率（IRM）的任何变化。在 ASCT 中，74.3%的移植患者发生≥1 次 FN 发作，各组之间无差异（P=0.66）。革兰氏阴性菌 PE-BSI 的 CIF 为 10.1%，FQ-P 存在显著差异（0%[LEVO 组] vs. 14.1%[NO-LEVO 组]，P=0.016）。两组的 IRM 的 CIF 均为 0%。在 allo-HSCT 中，96.4%的移植患者发生≥1 次 FN 发作，各组之间无差异（P=0.72）。革兰氏阴性菌 PE-BSI 的 CIF 为 28%，无 FQ-P 时显著升高（14.7%[LEVO 组] vs. 34.4%[NO-LEVO 组]，P=0.003）。两组的 IRM 的 CIF 均为 5%，无差异（P=0.62）。比较 allo-HSCT 中革兰氏阴性菌的抗菌药物耐药性，无 FQ-P 组的病原体对哌拉西林/他唑巴坦（71% vs. 30%，P=0.026）、氟喹诺酮（49% vs. 10%，P=0.03）和碳青霉烯类（95% vs. 50%，P=0.001）的敏感性显著更高。ASCT 和 allo-HSCT 中，停止使用 FQ-P 增加了革兰氏阴性菌 PE-BSI，但并未影响 IRM；重要的是，它还显著降低了革兰氏阴性菌的抗菌药物耐药性。
