1. ¹Department of Medicine, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV, USA
2. ²Department of Pharmacy, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV, USA
3. ³Department of Mathematics, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, Morgantown, WV, USA
4. ⁴Department of Medicine, University of Nebraska Medical Center, Omaha, NE, USA

Correspondence: Dr M Craig, Department of Medicine, Mary Babb Randolph Cancer Center, West Virginia University Hospitals, PO Box 9162, Morgantown, WV 26506-9162, USA. E-mail: craigm@wvuh.com

Received 25 January 2006; Accepted 12 December 2006; Published online 26 February 2007.

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.