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Impact of antibacterial prophylaxis during reinduction chemotherapy for relapse/refractory acute myeloid leukemia

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Abstract

Purpose

This study evaluated the impact of antibacterial prophylaxis with levofloxacin in relapsed/refractory acute myeloid leukemia (AML) patients.

Methods

This was a retrospective, single-center, cohort study. Adult patients with relapsed/refractory AML admitted for reinduction chemotherapy between November 1, 2006 and June 15, 2015 were screened for inclusion. A protocol initiating levofloxacin prophylaxis was implemented on December 1, 2013. Patients receiving hypomethylating agents (decitabine/azacitidine) were not administered antibacterial prophylaxis and thus not included in this analysis. Patients receiving broad spectrum antibiotics on day 1 of reinduction chemotherapy or receiving another antibacterial agent for prophylaxis were also excluded. Ninety-seven patients were included in the control group (no prophylaxis), while 48 patients received levofloxacin prophylaxis. Patients in the prophylaxis group received levofloxacin 500 mg once daily on day 1 of chemotherapy and continued until neutrophil recovery (or hospital discharge or death).

Results

There was a reduction in the rate of bacteremia in the prophylaxis group (37.5 %) compared to the control group (53.6 %, p = 0.0789), largely due to a reduction in gram-negative bacteremia (2.1 vs. 21.6 % respectively, p = 0.001). No difference was found between prophylaxis and the control groups in the incidence of neutropenic fever, incidence of multidrug resistance, length of hospital or ICU stay, or mortality.

Conclusions

Levofloxacin prophylaxis reduced the rate of infections overall in adult patients with relapsed/refractory AML, without increasing rates of multidrug-resistant organisms.

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Acknowledgments

Data collection using the REDCap software was supported by the Michigan Institute for Clinical and Health Research grant (CTSA:ULT1TR000433). We also acknowledge the University of Michigan Honest Broker Office for the assistance with data extraction from the electronic medical record.

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Authors and Affiliations

  1. Department of Pharmacy Services and College of Pharmacy, University of Michigan Health System, 1111 E. Catherine St., Rm 330, Ann Arbor, MI, 48109, USA

    Beejal R. Ganti, Bernard L. Marini, Jerod Nagel & Anthony J. Perissinotti

  2. Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA

    Beejal R. Ganti

  3. Division of Hematology-Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Dale Bixby

Authors
  1. Beejal R. Ganti
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  2. Bernard L. Marini
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  3. Jerod Nagel
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  4. Dale Bixby
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  5. Anthony J. Perissinotti
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Corresponding author

Correspondence to Anthony J. Perissinotti.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required, and as such, a waiver of informed consent was granted by the institutional review board.

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The authors declare that they have no conflicts of interest.

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Ganti, B.R., Marini, B.L., Nagel, J. et al. Impact of antibacterial prophylaxis during reinduction chemotherapy for relapse/refractory acute myeloid leukemia. Support Care Cancer 25, 541–547 (2017). https://doi.org/10.1007/s00520-016-3436-3

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  • DOI: https://doi.org/10.1007/s00520-016-3436-3

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