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Post-Transplant Events

The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit

Bone Marrow Transplantation volume 39, pages 477–482 (2007)Cite this article

Abstract

Febrile neutropenia is an expected complication during treatment of aggressive hematological malignancies and hematopoietic cell transplantation. We conducted a prospective cohort trial to determine the effects and safety of prophylactic fluoroquinolone administration, and rotation of empiric antibiotics for neutropenic fever in this patient population. From March 2002 through 2004, patients were treated with prophylactic levofloxacin during prolonged neutropenia, and a cycling schedule of empiric antibiotic therapy for neutropenic fever was initiated. The rates of bacteremia, resistance and complications were compared to a retrospective cohort of previously treated patients. The rate of gram-negative bacteremia decreased after the initiation of prophylactic levofloxacin (4.7 vs 1.8 episodes/1000 patient days, P<0.05). Gram-positive bacteremia rates remained unchanged, but more isolates of Enterococcus faecium were resistant to vancomycin after the intervention began. Resistance to the antibiotic agents used in the rotation did not emerge. There was no change in mortality during the intervention period. A prophylactic and cycling antibiotic schedule was successfully implemented on a hematological malignancy and hematopoietic cell transplant unit. gram-negative bacteremia was significantly decreased, without emergence of resistance. Concerns with Gram-positive resistance will require further observation.

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Acknowledgements

This work was supported in part by an unrestricted grant from Elan Pharmaceuticals, Inc. We thank Richard Shields, Pam Bunner, Robin Weisenborn, John Thomas, David Styers, Kim Evans and Renee Sager for their assistance with this project and publication.

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Authors and Affiliations

  1. Department of Medicine, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV, USA

    M Craig, A R Sarwari & S G Ericson

  2. Department of Pharmacy, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV, USA

    A D Cumpston

  3. Department of Mathematics, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV, USA

    G R Hobbs

  4. Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

    M P DeVetten

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  1. M Craig
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  2. A D Cumpston
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  3. G R Hobbs
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  4. M P DeVetten
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  5. A R Sarwari
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  6. S G Ericson
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Correspondence to M Craig.

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Craig, M., Cumpston, A., Hobbs, G. et al. The clinical impact of antibacterial prophylaxis and cycling antibiotics for febrile neutropenia in a hematological malignancy and transplantation unit. Bone Marrow Transplant 39, 477–482 (2007). https://doi.org/10.1038/sj.bmt.1705591

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