OBJECTIVE
To describe the effect of a combination prophylactic regimen of levofloxacin, a synthetic
chemotherapeutic antibiotic of the fluoroquinolone drug class, with either penicillin
or doxycycline on the changing epidemiology of bacterial infections and antimicrobial
resistance patterns of isolated organisms in the allogeneic hematopoietic stem cell
transplant (HSCT) patient population.
PATIENTS AND METHODS
We conducted a single-center, retrospective cohort study of all allogeneic HSCT recipients
from January 1, 2003, through August 31, 2008, who received prophylactic levofloxacin
in combination with penicillin (or with doxycycline in penicillin-allergic patients)
from allogeneic stem cell infusion until neutrophil engraftment.
RESULTS
Of the 258 patients who underwent allogeneic HSCT during the study period, 231 received
levofloxacin prophylaxis, 76 (33%) of whom developed an infection within 3 months
after transplant. Over time, the ratio of gram-positive to gram-negative (GN) infections
decreased from 2.11 in 2004, the first year that GN organisms were isolated, to 1.11
in 2008 (P=.20). Emergence of fluoroquinolone-resistant GN bacteria was observed (P=.02), whereas resistance to extended-spectrum β-lactams did not change over time.
Combined vancomycin-resistant enterococci colonization and infection rates increased
during the study period (P=.04). Clostridium difficile colitis was uncommon.
CONCLUSION
Levofloxacin with penicillin or doxycycline prophylaxis may contribute to the emergence
of resistant GN infections in allogeneic HSCT recipients over time. Our findings provide
additional support for the current standard of practice of administering empiric monotherapy
with an antipseudomonal β-lactam if these patients develop fever or are suspected
to have an infection.
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