Abstract
BackgroundInfections are a common cause of morbidity and mortality in patients with acute myeloid leukemia (AML). The evidence for efficacy of antibiotic prophylaxis in reducing the mortality rates and the incidence of bacterial infections was also reported by a systematic review published by Cochrane in 2012. The objective of our study was to report the incidence and the etiology of bloodstream infections in patients with AML undergoing levofloxacin prophylaxis during neutropenic episodes.MethodsThis was a retrospective study of patients with diagnosis of AML during 2001–2007.ResultsA total of 81 patients were included in the study. Two hundred and ninetyone neutropenic episodes were studied, of which 181 were febrile. Bacteria isolated from blood cultures were mostly Gram-positives during the induction (80%) and Gram-negatives during the consolidation (72.4%) phases of chemotherapy. Resistance to ciprofloxacin was found in 78.9% of isolated E. coli and it was higher during consolidation and higher than the hospital rate. The production of extended spectrum betalactamases (ESBL) in E. coli strains was reported in 12.1%, below the reported hospital rate during the study period.ConclusionsRegular microbiology surveillance is needed to better understand the impact of levofloxacin prophylaxis in neutropenic patients. Our study shows that Gram-positive bacteria are predominant during the induction phase of chemotherapy and Gram-negatives during the consolidation. The rate of fluoroquinolone resistance in the latter setting, even higher than the hospital rate, may suggest to reconsider levofloxacin prophylaxis.
Highlights
Infections are a common cause of morbidity and mortality in patients with acute myeloid leukemia (AML)
Standard treatment is conventionally divided into the induction phase with anthracycline and cytarabine and consolidation therapy consisting of cycles of chemotherapy or stem cell transplantation [1,2]
Empirical antifungal therapy and investigation for invasive fungal infections should be considered for patients with persistent or recurrent fever after 4–7 days of antibiotics and whose duration of neutropenia is expected to be >7 days [7]
Summary
Infections are a common cause of morbidity and mortality in patients with acute myeloid leukemia (AML). The evidence for efficacy of antibiotic prophylaxis in reducing the mortality rates and the incidence of bacterial infections was reported by a systematic review published by Cochrane in 2012. The objective of our study was to report the incidence and the etiology of bloodstream infections in patients with AML undergoing levofloxacin prophylaxis during neutropenic episodes. Infections are a common cause of morbidity and mortality in patients with AML. Levofloxacin prophylaxis during neutropenia for high risk patients has been shown to be effective to prevent all infection related events by a study published in 2005 by GIMEMA group and confirmed by a Cochrane systematic review in 2012 [5,6]. Preemptive antifungal management is acceptable as an alternative to empirical antifungal therapy in a subset of high-risk neutropenic patients [8,9]
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