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Microbial Issues

Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients

Bone Marrow Transplantation volume 46, pages 1231–1239 (2011)Cite this article

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Abstract

This study aimed to determine the impact of blood stream infections (BSIs) on outcome of allogeneic hematopoietic SCT (HSCT), and to examine the influence of old (non-levofloxacin-containing) and new (levofloxacin-based) prophylactic antibiotic protocols on the pattern of BSIs. We retrospectively enrolled 246 allogeneic HSCT recipients between January 1999 and June 2006, dividing patients into BSI (within 6 months post-HSCT, n=61) and non-BSI groups (n=185). We found that Gram-negative bacteria (GNB) predominated BSI pathogens (54%). Multivariate analyses showed that patients with a BSI, compared with those without, had a significantly greater 6-month mortality (hazard ratio, 1.75; 95% confidence interval, 1.09–2.82; P=0.021) and a significantly increased length of hospital (LOH) stay (70.8 vs 55.2 days, P=0.014). Moreover, recipients of old and new protocols did not have a significantly different 6-month mortality and time-to-occurrence of BSIs. However, there were significantly more resistant GNB to third-generation cephalosporins and carbapenem in recipients of levofloxacin-based prophylaxis. Our data suggest that BSIs occur substantially and impact negatively on the outcome and LOH stay after allogeneic HSCT despite antibiotic prophylaxis. Levofloxacin-based prophylaxis, albeit providing similar efficacy to non-levofloxacin-containing regimens, may be associated with increased antimicrobial resistance.

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Acknowledgements

This study was partially supported by a grant from the Taiwan Clinical Oncology Research Foundation, a grant from NSC95–2314-B-075–087 and grants from the Taipei Veterans General Hospital (V98A-029, V96-C1–090).

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  1. C-Y Liu and T-J Chiou: These authors contributed equally to this work.

Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    C-Y Liu, Y-C Lai, L-T Hsiao, J-H Liu, J-P Gau, P-M Chen & C-H Tzeng

  2. National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC

    C-Y Liu, Y-C Lai, L-J Huang, T-L Chen, L-T Hsiao, J-H Liu, J-P Gau, P-M Chen, C-H Tzeng & T-J Chiou

  3. Department of Medicine, National Yang Ming University Hospital, Taipei, Taiwan, ROC

    Y-C Lai & T-J Chiou

  4. Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    L-J Huang & T-L Chen

  5. Division of Biostatistics, Institute of Public Health, National Yang Ming University, Taipei, Taiwan, ROC

    Y-W Yang

  6. Division of Transfusion Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

    T-J Chiou

  7. Department of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC

    T-J Chiou

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Liu, CY., Lai, YC., Huang, LJ. et al. Impact of bloodstream infections on outcome and the influence of prophylactic oral antibiotic regimens in allogeneic hematopoietic SCT recipients. Bone Marrow Transplant 46, 1231–1239 (2011). https://doi.org/10.1038/bmt.2010.286

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