Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study
Background and objectives: acute myeloid leukemia (AML) patients are at high risk of infections during post induction neutropenia. Recently, the role of antibacterial prophylaxis has been reconsidered due to concerns about the emergence of multi-resistant pathogens. Aim of the present study was t...
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PAGEPress Publications
2023-02-01
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| Series: | Mediterranean Journal of Hematology and Infectious Diseases |
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| Online Access: | http://www.mjhid.org/index.php/mjhid/article/view/5258 |
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| author | Irene Urbino Chiara Frairia Alessandro Busca Silvia Corcione Stefano D'Ardia Chiara Maria Dellacasa Valentina Giai Carolina Secreto Roberto Freilone Francesco Giuseppe De Rosa Semra Aydin Giovannino Ciccone Rosalba Rosato Marco Cerrano Ernesta Audisio |
| author_facet | Irene Urbino Chiara Frairia Alessandro Busca Silvia Corcione Stefano D'Ardia Chiara Maria Dellacasa Valentina Giai Carolina Secreto Roberto Freilone Francesco Giuseppe De Rosa Semra Aydin Giovannino Ciccone Rosalba Rosato Marco Cerrano Ernesta Audisio |
| author_sort | Irene Urbino |
| collection | DOAJ |
| description |
Background and objectives: acute myeloid leukemia (AML) patients are at high risk of infections during post induction neutropenia. Recently, the role of antibacterial prophylaxis has been reconsidered due to concerns about the emergence of multi-resistant pathogens. Aim of the present study was to evaluate the impact of prophylaxis omission on the rate of induction death (primary endpoint), neutropenic fevers, bloodstream infections (BSIs), resistant pathogens BSIs and septic shocks (secondary endpoints). Methods: we performed a retrospective single center study including 373 AML patients treated with intensive induction chemotherapy, divided in two groups according to levofloxacin prophylaxis given (group A, gA) or not (group B, gB). Results: neutropenic fever was observed in 91% of patients in gA and 97% in gB (OR 0.35, IC95% 0.08 – 1.52, p=0162).The rate of BSIs was 27% in gA compared to 34% in gB (OR 0.69, 0.38 – 1.25, p=0.222). Induction death rate was 5% in gA and 3% in gB (OR 1.50, 0.34 – 6.70, p=0.284). Fluoroquinolones (FQ) resistant pathogens were responsible for 59% of total BSIs in gA and 22% in gB (OR 5.07, 1.87 – 13.73, p=0.001); gram-negative BSIs due to multi-drug resistant organisms were 31% in gA and 36% in gB (OR 0.75, 0.15 – 3.70, p=0.727). Conclusions: levofloxacin prophylaxis omission was not associated with an increased risk of induction death. Cumulative incidence of neutropenic fever was higher in non-prophylaxis group, while no difference was observed for BSIs. In the prophylaxis group we observed a higher incidence of FQ resistant organisms.
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| format | Article |
| id | doaj-art-d0581b4b379640d0a9a8451bf09c3429 |
| institution | Kabale University |
| issn | 2035-3006 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | PAGEPress Publications |
| record_format | Article |
| series | Mediterranean Journal of Hematology and Infectious Diseases |
| spelling | doaj-art-d0581b4b379640d0a9a8451bf09c34292025-01-02T23:11:06ZengPAGEPress PublicationsMediterranean Journal of Hematology and Infectious Diseases2035-30062023-02-0115110.4084/MJHID.2023.022Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center studyIrene Urbino0Chiara Frairia1Alessandro Busca2Silvia Corcione3Stefano D'Ardia4Chiara Maria Dellacasa5Valentina Giai6Carolina Secreto7Roberto Freilone8Francesco Giuseppe De Rosa9Semra Aydin10Giovannino Ciccone11Rosalba Rosato12Marco Cerrano13Ernesta Audisio14Department of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, SSCVD Trapianto di Cellule Staminali, Città della Salute e della Scienza, Turin, ItalyDepartment of Medical Sciences, Unit of Infectious Diseases, University of Turin, Turin, Italy; Tufts University School of Medicine, Boston, MA, USADepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, SSCVD Trapianto di Cellule Staminali, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Medical Sciences, Unit of Infectious Diseases, University of Turin, Turin, ItalyDepartment of Oncology, Hematology, Immuno-oncology and Rheumatology, University Hospital of Bonn, Bonn, Germany; Department of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyUnit of Clinical Epidemiology, CPO, Città della Salute e della Scienza, Turin, ItalyUnit of Clinical Epidemiology, CPO, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, ItalyDepartment of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, Italy Background and objectives: acute myeloid leukemia (AML) patients are at high risk of infections during post induction neutropenia. Recently, the role of antibacterial prophylaxis has been reconsidered due to concerns about the emergence of multi-resistant pathogens. Aim of the present study was to evaluate the impact of prophylaxis omission on the rate of induction death (primary endpoint), neutropenic fevers, bloodstream infections (BSIs), resistant pathogens BSIs and septic shocks (secondary endpoints). Methods: we performed a retrospective single center study including 373 AML patients treated with intensive induction chemotherapy, divided in two groups according to levofloxacin prophylaxis given (group A, gA) or not (group B, gB). Results: neutropenic fever was observed in 91% of patients in gA and 97% in gB (OR 0.35, IC95% 0.08 – 1.52, p=0162).The rate of BSIs was 27% in gA compared to 34% in gB (OR 0.69, 0.38 – 1.25, p=0.222). Induction death rate was 5% in gA and 3% in gB (OR 1.50, 0.34 – 6.70, p=0.284). Fluoroquinolones (FQ) resistant pathogens were responsible for 59% of total BSIs in gA and 22% in gB (OR 5.07, 1.87 – 13.73, p=0.001); gram-negative BSIs due to multi-drug resistant organisms were 31% in gA and 36% in gB (OR 0.75, 0.15 – 3.70, p=0.727). Conclusions: levofloxacin prophylaxis omission was not associated with an increased risk of induction death. Cumulative incidence of neutropenic fever was higher in non-prophylaxis group, while no difference was observed for BSIs. In the prophylaxis group we observed a higher incidence of FQ resistant organisms. http://www.mjhid.org/index.php/mjhid/article/view/5258acute myeloid leukemialevofloxacin prophylaxisbloodstream infectionsinduction deathantibiotic resistance |
| spellingShingle | Irene Urbino Chiara Frairia Alessandro Busca Silvia Corcione Stefano D'Ardia Chiara Maria Dellacasa Valentina Giai Carolina Secreto Roberto Freilone Francesco Giuseppe De Rosa Semra Aydin Giovannino Ciccone Rosalba Rosato Marco Cerrano Ernesta Audisio Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study Mediterranean Journal of Hematology and Infectious Diseases acute myeloid leukemia levofloxacin prophylaxis bloodstream infections induction death antibiotic resistance |
| title | Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study |
| title_full | Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study |
| title_fullStr | Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study |
| title_full_unstemmed | Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study |
| title_short | Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study |
| title_sort | levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia a single center study |
| topic | acute myeloid leukemia levofloxacin prophylaxis bloodstream infections induction death antibiotic resistance |
| url | http://www.mjhid.org/index.php/mjhid/article/view/5258 |
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