Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA.
J Pediatric Infect Dis Soc. 2023 Jul 31;12(7):381-391. doi: 10.1093/jpids/piad041.
Levofloxacin prophylaxis (LVXp) is often used for patients with underlying leukemia and severe neutropenia to reduce the risk of fever and bacteremia. This study evaluated trends in viridans group streptococci (VGS) antibiotic susceptibilities over time and clinical outcomes of children with VGS bloodstream infections (BSIs) during institutional adoption of LVXp.
VGS blood culture isolates between 1/1/2010 and 12/31/2021 with susceptibility testing reported were included. Available isolates were re-identified to the species level and additional susceptibility testing was performed. Demographic and clinical data were abstracted from medical records.
A total of 264 VGS BSI isolates were identified in immunocompromised (IC, n = 125) and non-immunocompromised subjects, (non-IC, n = 139). IC subjects had lower rates of VGS isolates susceptible (S) to LVX and higher minimum inhibitory concentration (MICs) to LVX (p = 0.004) and ciprofloxacin (p = 0.0005) compared with non-IC subjects. No other evaluated antibiotic had increased MICs in either group. Fifteen of 19 (74%) LVX not susceptible (NS) isolates occurred in IC subjects, 13 represented breakthrough infections. IC subjects had higher rates of VGS-related shock (p = 0.012), need for pressor support (p = 0.039), and longer duration of hospitalization than non-IC subjects (p < 0.001). Clinical outcomes were comparable between subjects with LVX S and NS VGS BSI isolates.
VGS with reduced susceptibility to LVX emerged during institutional adoption of LVXp in high-risk children with immunocompromising conditions, but did not result in significant differences in clinical outcomes. Ongoing surveillance and susceptibility testing are critical in weighing the utility of LVXp against emerging antimicrobial resistance in this high-risk population.
左氧氟沙星预防（LVXp）常用于伴有基础白血病和严重中性粒细胞减少症的患者，以降低发热和菌血症的风险。本研究评估了在机构采用 LVXp 期间，时间推移时变异链球菌（VGS）对抗生素敏感性的趋势以及 VGS 血流感染（BSI）患儿的临床结局。
纳入了 2010 年 1 月 1 日至 2021 年 12 月 31 日期间进行药敏试验报告的 VGS 血培养分离株。对可获得的分离株进行了种水平的重新鉴定，并进行了额外的药敏试验。从病历中提取人口统计学和临床数据。
共鉴定出 264 株免疫功能低下（IC，n=125）和非免疫功能低下（非 IC，n=139）患者的 VGS BSI 分离株。IC 患者对 LVX 的敏感（S）率较低，对 LVX（p=0.004）和环丙沙星（p=0.0005）的最小抑菌浓度（MIC）较高，而非 IC 患者则较低。两组均未发现其他评估抗生素的 MIC 升高。19 株不耐受 LVX（NS）的分离株中有 15 株（74%）发生在 IC 患者中，其中 13 株为突破感染。IC 患者 VGS 相关休克（p=0.012）、需要升压支持（p=0.039）和住院时间较长（p<0.001）的发生率高于非 IC 患者。LVX S 和 NS VGS BSI 分离株的临床结局相似。
在高危免疫功能低下儿童中采用 LVXp 期间，出现了对 LVX 敏感性降低的 VGS，但在临床结局方面没有显著差异。在这一高危人群中，对抗微生物耐药性的出现，持续监测和药敏试验至关重要。
