Levofloxacin Prophylaxis for Multiple Myeloma Patients Undergoing Autologous Transplant

Topic Significance & Study Purpose/Background/Rationale

Development of bacteremia in the presence of a central line is a monitored nursing sensitive indicator. It also affects the nurses’ ability to care for the BMT patient since the central line is usually removed when this diagnosis is made. A randomized controlled study evaluating the efficacy of short term versus long term cryotherapy during Melphalan administration for the prevention of severe mucositis was recently completed at our institution. One of the data pieces collected during this nursing intervention study was the development of bacteremia. Greater than 20% of the study patients developed bacteremia. Retrospective review showed that prior to cryotherapy implementation the rate was nearly 0%, however, it was noted that Ciprofloxacin prophylaxis was being used during that period.

Methods, Intervention, & Analysis

Study data as well as a literature review was presented during a BMT program quality meeting where multidisciplinary team members, including  Epidemiology, were present for discussion. Based on the organisms identified (many Gram negative organisms likely translocated via the damaged GI mucosa), the day of transplant on which they were identified (Day +6 to +10), and the concern for increased incidence of C. difficile, a plan was agreed upon. Levofloxacin is now being administered beginning on Day +4 until Day +9 to patients with Multiple Myeloma who are receiving an autologous BMT with Melphalan as the preparative regimen.

Findings & Interpretation

Analysis of 2 months of data (24 patients) shows the bloodstream infection rate is down to <5% and the rate of C. difficile has not changed. Although this is a small sample of data, more than 6 months of data will be available prior to presentation at the Tandem meeting.

Discussion & Implications

This practice change was implemented in a controlled single population. Based on the impact already noted, our program is considering implementing this same practice change to other populations who also receive Melphalan as part of their preparative regimen. This practice change has positively impacted patients by allowing them to keep their central line throughout their transplant course and eliminating the need for them to be discharged on antibiotic therapy. Continued data monitoring related to this change is occurring.