Bacteremia in Hematopoietic Stem Cell Recipients Receiving Fluoroquinolone Prophylaxis: Incidence, Resistance, and Risk Factors
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Materials and methods: This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia. Results: There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively. Conclusion: High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone.
Abstract
Background: Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Materials and methods: This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia. Results: There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively. Conclusion: High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone.
참고문헌 (29)
- Poutsiaka DD, "Blood stream infection after hematopoietic stem cell transplantation is associated with increased mortality", Bone Marrow Transplant, 40, pp.63~70 (2007)
- Wang CH, "Characteristics comparisons of bacteremia in allogeneic and autologous hematopoietic stem celltransplant recipients with levofloxacin prophylaxis and influence on resistant bacteria emergence", J Microbiol Immunol Infect, 51, pp.123~131 (2018)
- Piñana JL, "Incidence, risk factors, and outcome of bacteremia following autologous hematopoietic stem cell transplantation in 720 adult patients", Ann Hematol, 93, pp.299~307 (2014)
- Blennow O, "Incidence, risk factors, and outcome of bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations", Transpl Infect Dis, 16, pp.106~114 (2014)
- Cullen M, "Prevention of febrile neutropenia : use of prophylactic antibiotics", Br J Cancer, 101(Suppl 1), pp.S11~S14 (2009)
- Freifeld AG, "Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer : 2010 Update by the Infectious Diseases Society of America", Clin Infect Dis, 52, pp.427~431 (2011)
- Kimura S, "Antibiotic prophylaxis in hematopoietic stem cell transplantation. A meta-analysis of randomized controlled trials", J Infect, 69, pp.13~25 (2014)
- Modi D, "Fluoroquinolone prophylaxis in autologous hematopoietic stem cell transplant recipients", Support Care Cancer, 25, pp.2593~2601 (2017)
- Bow EJ, "Fluoroquinolones, antimicrobial resistance and neutropenic cancer patients", Curr Opin Infect Dis, 24, pp.545~553 (2011)
- Gözel MG, "AYPAK A, Gönen İbak, Gürpinar EU, İşli F, Süzük Yildiz S, Yarsan E, Bodur H. Antibiotic consumption, resistance data, and prevention strategies", Mediterr J Infect Microb Antimicrob, 7, pp.35~ (2018)
- Signorelli J, "Incidence of febrile neutropenia in autologous hematopoietic stem cell transplant(HSCT)recipients on levofloxacin prophylaxis", Transpl Infect Dis, 22, pp.e13225~ (2020)
- El-Ghammaz AMS, "Bacteremia during early post-allogeneic hematopoietic stem cell transplantation period : A single center experience", Indian J Hematol Blood Transfus, 33, pp.200~206 (2017)
- Ali N, "Bloodstream and central line isolates from hematopoietic stem cell transplant recipients : data from a developing country", Transpl Infect Dis, 16, pp.98~105 (2014)
- Misch EA, "Bacterial infections in the stem cell transplant recipient and hematologic malignancy patient", Infect Dis Clin North Am, 33, pp.399~445 (2019)
- Secreto C, "The management of hematologic patients with bloodstream infections due to multi-drug resistant bacteria: Where do we stand? from antibacterial prophylaxis to the treatment of septic shock", Hemato, 1, pp.60~76 (2020)
- Dandoy CE, "Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient : new considerations for a persistent nemesis", Bone Marrow Transplant, 52, pp.1091~1106 (2017)
- Mitchell AE, "Gram-negative bacteraemia(GNB)after 428 unrelated donor bone marrow transplants(UD-BMT) : risk factors, prophylaxis, therapy and outcome", Bone Marrow Transplant, 33, pp.303~310 (2004)
- Busca A, "Blood stream infections after allogeneic stem cell transplantation : a single-center experience with the use of levofloxacin prophylaxis", Transpl Infect Dis, 14, pp.40~48 (2012)
- Castagnola E, "Management of bacteremia in patients undergoing hematopoietic stem cell transplantation", Expert Rev Anti Infect Ther, 7, pp.607~621 (2009)
- Mikulska M, "Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia : ECIL critical appraisal of previous guidelines", J Infect, 76, pp.20~37 (2018)
- Laoprasopwattana K, "Ciprofloxacin reduces occurrence of fever in children with acute leukemia who develop neutropenia during chemotherapy", Pediatr Infect Dis J, 32, pp.e94~e98 (2013)
- Verlinden A, "Clinical and microbiological impact of discontinuation of fluoroquinolone prophylaxis in patients with prolonged profound neutropenia", Eur J Haematol, 93, pp.302~308 (2014)
- Gafter-Gvili A, "Effect of quinolone prophylaxis in afebrile neutropenic patients on microbial resistance : systematic review and meta-analysis", J Antimicrob Chemother, 59, pp.5~22 (2007)
- Averbuch D, "Antimicrobial resistance in Gram-negative rods causing bacteremia in hematopoietic stem cell transplant recipients : Intercontinental prospective study of the infectious diseases working party of the European bone marrow transplantation group", Clin Infect Dis, 65, pp.1819~1828 (2017)
- Tural Kara T, "Bloodstream infections in pediatric hematology", oncology patients : Six years’ experience of a single center in Turkey, 2019, pp.49, 1157~1164
- Craig M, "The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit", Bone Marrow Transplant, 39, pp.477~482 (2007)
- Chong Y, "Clinical impact of fluoroquinolone prophylaxis in neutropenic patients with hematological malignancies", Int J Infect Dis, 15, pp.e277~e281 (2011)
- Türk Daği H, "Antibiotic resistance in enterococci isolated from blood cultures", Turk Mikrobiyol Cem Derg, 41, pp.103~106 (2011)
- Ödemiş İ, "Evaluation of antibiotic susceptibilities of enterococcus strains isolated from clinical samples of hospitalized patients", Turk Hij Den Biyol Derg, 75, pp.345~352 (2018)