Gaffney Kelly J, Urban Theresa A, Lucena Mariana, Rybicki Lisa, Majhail Navneet S, Mossad Sherif Beniameen
Malignant Hematology & Blood Marrow Transplant, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29401, USA.
Cleveland Clinic, Cleveland, USA.
Clin Hematol Int. 2023 Jun;5(2-3):65-70. doi: 10.1007/s44228-023-00029-7. Epub 2023 Feb 4.
Our institution has used trimethoprim-sulfamethoxazole (TMP-SMX) as the antibacterial agent of choice for infection prophylaxis during the pre-engraftment period in the allogeneic transplant (allo-HCT) population.
This retrospective, single center study was developed to compare the safety of that antibacterial prophylaxis to fluoroquinolones in allo-HCT. The primary endpoint was time to neutrophil engraftment.
A total of 366 patients were reviewed (TMP-SMX n = 332, fluoroquinolone n = 34). No difference in days to neutrophil engraftment was found (median 15 versus 16 days, p = 0.62). Hyperkalemia was more common in the TMP-SMX cohort (32.2% versus 14.7%, p = 0.035); this did not contribute to a higher rate of agent discontinuation or arrhythmia. There was no significant difference in the incidence of neutropenic fever; however, those in the TMP-SMX cohort were more likely to have microbiologically confirmed bacteremia (24.1% versus 8.8% respectively, p = 0.043). There was no significant difference in infections. No long-term implication of prophylactic antibacterial agent selection was observed in terms of graft-versus-host-disease, underlying disease relapse, or mortality.
The use of TMP-SMX was associated with a higher likelihood of bacteremia and hyperkalemia; however, this did not result in increased hospital stay, escalation of care, or mortality. The use of TMP-SMX for prophylaxis during the pre-engraftment period for allo-HCT recipients is safe and effective.
我们机构在异基因移植（allo-HCT）人群的植入前期将甲氧苄啶-磺胺甲恶唑（TMP-SMX）用作预防感染的首选抗菌药物。
开展这项回顾性单中心研究以比较该抗菌预防措施与氟喹诺酮类药物在allo-HCT中的安全性。主要终点是中性粒细胞植入时间。
共纳入366例患者（TMP-SMX组n = 332，氟喹诺酮组n = 34）。中性粒细胞植入天数无差异（中位数分别为15天和16天，p = 0.62）。高钾血症在TMP-SMX组更常见（32.2%对14.7%，p = 0.035）；但这并未导致更高的药物停用率或心律失常发生率。中性粒细胞减少性发热的发生率无显著差异；然而，TMP-SMX组患者更可能发生微生物学确诊的菌血症（分别为24.1%对8.8%，p = 0.043）。感染方面无显著差异。在移植物抗宿主病、基础疾病复发或死亡率方面，未观察到预防性抗菌药物选择的长期影响。
使用TMP-SMX与菌血症和高钾血症的较高可能性相关；然而，这并未导致住院时间延长、治疗升级或死亡率增加。在allo-HCT受者的植入前期使用TMP-SMX进行预防是安全有效的。
