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Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study

BACKGROUND: 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. The aim of the present study was to evaluate the...

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Autores principales: Urbino, Irene, Frairia, Chiara, Busca, Alessandro, Corcione, Silvia, D’Ardia, Stefano, Dellacasa, Chiara Maria, Giai, Valentina, Secreto, Carolina, Freilone, Roberto, De Rosa, Francesco Giuseppe, Aydin, Semra, Ciccone, Giovannino, Rosato, Rosalba, Cerrano, Marco, Audisio, Ernesta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Università Cattolica del Sacro Cuore 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10000898/
https://www.ncbi.nlm.nih.gov/pubmed/36908871
http://dx.doi.org/10.4084/MJHID.2023.022
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author Urbino, Irene
Frairia, Chiara
Busca, Alessandro
Corcione, Silvia
D’Ardia, Stefano
Dellacasa, Chiara Maria
Giai, Valentina
Secreto, Carolina
Freilone, Roberto
De Rosa, Francesco Giuseppe
Aydin, Semra
Ciccone, Giovannino
Rosato, Rosalba
Cerrano, Marco
Audisio, Ernesta
author_facet Urbino, Irene
Frairia, Chiara
Busca, Alessandro
Corcione, Silvia
D’Ardia, Stefano
Dellacasa, Chiara Maria
Giai, Valentina
Secreto, Carolina
Freilone, Roberto
De Rosa, Francesco Giuseppe
Aydin, Semra
Ciccone, Giovannino
Rosato, Rosalba
Cerrano, Marco
Audisio, Ernesta
author_sort Urbino, Irene
collection PubMed
description BACKGROUND: 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. The aim of the present study was to evaluate the impact of avoiding prophylaxis 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 into 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). The 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: Despite its limitations (retrospective nature, single-center, different cohort size), the present study showed that avoiding levofloxacin prophylaxis was not associated with an increased risk of induction death. The 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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spelling pubmed-100008982023-03-11 Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study Urbino, Irene Frairia, Chiara Busca, Alessandro Corcione, Silvia D’Ardia, Stefano Dellacasa, Chiara Maria Giai, Valentina Secreto, Carolina Freilone, Roberto De Rosa, Francesco Giuseppe Aydin, Semra Ciccone, Giovannino Rosato, Rosalba Cerrano, Marco Audisio, Ernesta Mediterr J Hematol Infect Dis Original Article BACKGROUND: 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. The aim of the present study was to evaluate the impact of avoiding prophylaxis 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 into 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). The 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: Despite its limitations (retrospective nature, single-center, different cohort size), the present study showed that avoiding levofloxacin prophylaxis was not associated with an increased risk of induction death. The 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. Università Cattolica del Sacro Cuore 2023-03-01 /pmc/articles/PMC10000898/ /pubmed/36908871 http://dx.doi.org/10.4084/MJHID.2023.022 Text en https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Urbino, Irene
Frairia, Chiara
Busca, Alessandro
Corcione, Silvia
D’Ardia, Stefano
Dellacasa, Chiara Maria
Giai, Valentina
Secreto, Carolina
Freilone, Roberto
De Rosa, Francesco Giuseppe
Aydin, Semra
Ciccone, Giovannino
Rosato, Rosalba
Cerrano, Marco
Audisio, Ernesta
Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study
title Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study
title_full Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study
title_fullStr Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study
title_full_unstemmed Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study
title_short Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single Center Study
title_sort levofloxacin prophylaxis versus no prophylaxis in acute myeloid leukemia during post-induction aplasia: a single center study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10000898/
https://www.ncbi.nlm.nih.gov/pubmed/36908871
http://dx.doi.org/10.4084/MJHID.2023.022
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