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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...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Università Cattolica del Sacro Cuore
2023
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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. |
format | Online Article Text |
id | pubmed-10000898 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Università Cattolica del Sacro Cuore |
record_format | MEDLINE/PubMed |
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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