AI Article Synopsis
- The study examined the effects of avoiding levofloxacin antibacterial prophylaxis in 373 AML patients undergoing chemotherapy on various health outcomes like induction death, neutropenic fevers, and bloodstream infections (BSIs).
- Results indicated that while neutropenic fever rates were higher in the group without prophylaxis, there was no significant difference in induction death rates or overall BSI rates between the two groups.
- Significantly, the prophylaxis group had a higher incidence of fluoroquinolone-resistant pathogens, which raises concerns about the potential risks associated with antibiotic use in this vulnerable patient population.
Article Abstract
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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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10000898 | PMC |
| http://dx.doi.org/10.4084/MJHID.2023.022 | DOI Listing |
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