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Ciprofloxacin prophylaxis is associated with a lower incidence of gram-negative bacteremia in patients undergoing allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 55, pages 2319–2321 (2020)Cite this article

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Antibiotic prophylaxis in the period around allogeneic hematopoietic cell transplantation (allo-HCT) can be employed to reduce febrile episodes and infectious complications, mainly bacterial bloodstream infections [1, 2]. Antibiotic prophylaxis with fluoroquinolones is thought to prevent bacteremia by decreasing the prevalence of oral and intestinal pathogens, as these are common sites for bacterial translocation during HCT-associated neutropenia. While intuitive, routine antibiotic prophylaxis remains controversial due to unproven benefits and potential risks. A meta-analysis of randomized studies on systemic antibiotic prophylaxis in HCT recipients demonstrated reduction in infections without significant impact on all-cause or infection-related mortality [3]. Yet increased exposure to fluoroquinolones in the peritransplant period has been correlated with an increased incidence of fluoroquinolone-resistant bacteremia early after HCT [4]. Furthermore, disruptions in the intestinal microbiome early after allo-HCT are associated with the increased risk for acute graft-versus-host disease (GVHD) and lower overall survival (OS) [5, 6]. Early systemic antibiotic exposure has been identified as a possible contributor to low microbial diversity and deleterious clinical outcomes after transplant [7,8,9,10]. We therefore sought to characterize our institutional experience and associated outcomes with ciprofloxacin prophylaxis in allo-HCT.

In this retrospective cohort analysis, we compared our single-center experience using standard prophylactic ciprofloxacin in 97 consecutive adult patients (age ≥ 18 years) with the outcomes of 46 consecutive patients undergoing allo-HCT without peri-HCT antibiotic prophylaxis. Our historical institutional practice was to administer antibiotic prophylaxis with ciprofloxacin 500 mg twice daily, starting on day −1 until neutrophil engraftment with escalation of therapy for febrile neutropenia or documented infection. During a 6-month investigational period, routine antibiotic prophylaxis was not administered. This cohort of patients not receiving antibiotic prophylaxis was compared with consecutive patients in the 6 months prior and 7 months after. Clinical data were extracted from the institutional database and individual medical record of each patient. The current analysis was approved by the Institutional Review Board at the Dana-Farber/Harvard Cancer Center.

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Fig. 1: Bacteremia follow allo-HCT.

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Authors and Affiliations

  1. Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    A. Katie Maurer

  2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA

    Shuli Li

  3. Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA, USA

    Bradley D. Hunter, Susan E. O’Donnell, Bimalangshu R. Dey, Areej El-Jawahri, Matthew J. Frigault, Steven McAfee, Paul V. O’Donnell, Thomas R. Spitzer, Yi-Bin Chen & Zachariah DeFilipp

  4. Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA

    Samantha O. Luk

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Correspondence to Zachariah DeFilipp.

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Maurer, A.K., Li, S., Hunter, B.D. et al. Ciprofloxacin prophylaxis is associated with a lower incidence of gram-negative bacteremia in patients undergoing allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 55, 2319–2321 (2020). https://doi.org/10.1038/s41409-020-0923-4

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