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Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Presentation recording not available for download or distribution as requested by the presenting author.
Background: National guidelines recommend antimicrobial prophylaxis for allogeneic hematopoietic stem cell transplant (HCT) patients during the pre-engraftment period due to increased infection risk. Fluoroquinolones have demonstrated lower rates of bacteremia and incidence of neutropenic fever, but there is limited evidence for the use of alternative antibacterials, such as cefpodoxime, for patients with an allergy or adverse effect to fluoroquinolones.
Methods: This is a single-center, retrospective chart review of adult patients who received an allogeneic HCT from matched related or matched unrelated donors and received antibacterial prophylaxis with levofloxacin or cefpodoxime from January 1, 2011 to September 1, 2013. The primary objective of this study is to compare the rates of antibiotic prophylaxis failure between levofloxacin and cefpodoxime in allogeneic HCT recipients. Secondary objectives include comparing and characterizing number and type of infections, mortality at day 100 post-transplant, and hospitalizations for infectious causes in the first 100 days of transplant. Additionally, the emergence of resistance with quinolone and cephalosporin resistant isolates and number of multi-drug resistant (MDR) infections are characterized.
Results: A total of 80 patients were evaluated (40 levofloxacin, 40 cefpodoxime). Both levofloxacin and cefpodoxime groups had similar median age, underlying malignancy, stem cell source and transplant type. In the levofloxacin group, 70% of patients received myeloablative conditioning versus 83% in the cefpodoxime group. Median antimicrobial prophylaxis days were 10 versus 12 days for levofloxacin and cefpodoxime respectively. For levofloxacin and cefpodoxime groups respectively, neutropenic fever occurred in 27 patients (68%) vs. 22 patients (55%), with antibiotic escalation occurring in 93% and 92% of patients with neutropenic fever. In those patients requiring antibiotic escalation, 60% and 52% of patients had positive cultures in levofloxacin versus cefpodoxime groups, respectively. There were similar incidences of C. difficile and MDR infections among both levofloxacin and cefpodoxime groups. However, higher rates of extended spectrum beta-lactamase-producing E. coli infections were observed in the cefpodoxime group and higher rates of methicillin-resistant Staphylococcus aureus infections were noted in the levofloxacin group. Rates of infections, hospitalizations, and mortality in the first 100 days were similar among both groups.
Conclusion: Though this chart review was limited by a small sample size, similar rates of antibiotic prophylaxis failure were demonstrated with the levofloxacin and cefpodoxime groups. Cefpodoxime can be considered as an alternative to levofloxacin for antibiotic prophylaxis in allogeneic stem cell transplant patients.
Methods: This is a single-center, retrospective chart review of adult patients who received an allogeneic HCT from matched related or matched unrelated donors and received antibacterial prophylaxis with levofloxacin or cefpodoxime from January 1, 2011 to September 1, 2013. The primary objective of this study is to compare the rates of antibiotic prophylaxis failure between levofloxacin and cefpodoxime in allogeneic HCT recipients. Secondary objectives include comparing and characterizing number and type of infections, mortality at day 100 post-transplant, and hospitalizations for infectious causes in the first 100 days of transplant. Additionally, the emergence of resistance with quinolone and cephalosporin resistant isolates and number of multi-drug resistant (MDR) infections are characterized.
Results: A total of 80 patients were evaluated (40 levofloxacin, 40 cefpodoxime). Both levofloxacin and cefpodoxime groups had similar median age, underlying malignancy, stem cell source and transplant type. In the levofloxacin group, 70% of patients received myeloablative conditioning versus 83% in the cefpodoxime group. Median antimicrobial prophylaxis days were 10 versus 12 days for levofloxacin and cefpodoxime respectively. For levofloxacin and cefpodoxime groups respectively, neutropenic fever occurred in 27 patients (68%) vs. 22 patients (55%), with antibiotic escalation occurring in 93% and 92% of patients with neutropenic fever. In those patients requiring antibiotic escalation, 60% and 52% of patients had positive cultures in levofloxacin versus cefpodoxime groups, respectively. There were similar incidences of C. difficile and MDR infections among both levofloxacin and cefpodoxime groups. However, higher rates of extended spectrum beta-lactamase-producing E. coli infections were observed in the cefpodoxime group and higher rates of methicillin-resistant Staphylococcus aureus infections were noted in the levofloxacin group. Rates of infections, hospitalizations, and mortality in the first 100 days were similar among both groups.
Conclusion: Though this chart review was limited by a small sample size, similar rates of antibiotic prophylaxis failure were demonstrated with the levofloxacin and cefpodoxime groups. Cefpodoxime can be considered as an alternative to levofloxacin for antibiotic prophylaxis in allogeneic stem cell transplant patients.
Disclosures:
Nothing To Disclose