Bacteremia during Neutropenic Episodes in Children Underwent Hematopoietic Stem Cell Transplantation Receiving Ciprofloxacin and Penicillin Prophylaxis

Bacteremia during neutropenic episodes is a cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT).  Fluoroquinolones has been recommended for prevention of bacterial infections in HSCT recipients.  Our center has been used oral ciprofloxacin and penicillin V, started from beginning of preparative regimen until engraftment, for bacterial infection prophylaxis.  The objective of this study was to analyze the prevalence and risk factor of breakthrough bacteremia during neutropenic episodes in childhood HSCT patients.  There were 215 patients (M:F=1.26:1) with a median age of  8.32 years (range, 0.51-21.64 years) during 2006-2014. The common underlying diseases were thalassemia and acute leukemia. The median day of receiving antibiotic prophylaxis was 11 days (range, 1-38 days). The most common reason for discontinuation of antibiotic prophylaxis was febrile neutropenia (64.5%). Microbiologically documented bacterial infections were found in 66 patients (30.7%) which 33 patients (15.3%) had bacteremia. Escherichia coli (n=13) was the most commonly isolated gram negative bacteria while Staphylococcus spp. (n=3) and Streptococcus spp. (n=3) were the two most common gram positive bacteria.  Risk factor for bacteremia was receiving ATG-containing regimen (OR 2.67; 95%CI, 1.24-5.77). Other characteristics including age, diagnosis, preparative regimen, source of stem cells, or type of donor was not associated with bacteremia. Patients with bacteremia had a higher rate of mortality compared to those without bacteremia (36.4% vs 13.3%, p=0.001). No serious complication associated with ciprofloxacin or penicillin V was found in this study. In conclusion, this study demonstrated the feasibility and efficacy of ciprofloxacin and penicillin V prophylaxis in children underwent HSCT.  ATG-containing preparative regimen was the significant risk for bacteremia during neutropenic episodes.