Levofloxacin prophylaxis may significantly reduce rates of central line-associated bloodstream infections (CLABSIs) and neutropenic fever in patients undergoing autologous stem cell transplant (SCT), according to study results published in Biology of Blood and Marrow Transplantation.

Patients undergoing SCT to treat hematologic malignancies are at increased risk for CLABSIs. However, it is unclear whether there is a benefit to using prophylactic antibiotics to prevent CLABSIs in the setting of autologous SCT.

A team of researchers retrospectively assessed 324 patients undergoing autologous SCT; 150 received levofloxacin prophylaxis during the intervention period and the remaining 174 formed the baseline group. Patients received 500 mg oral levofloxacin daily for 13 days after undergoing SCT or until experiencing engraftment or neutropenic fever, whichever occurred first.

The incidence of CLABSIs was 18.4% in the baseline group and 6.0% in the levofloxacin group. Using multivariable analysis, the researchers found that levofloxacin prophylaxis significantly reduced CLABSI incidence (hazard ratio 0.33; P =.003) and risk for neutropenic fever (odds ratio [OR] 0.23; P <.001). The study also showed a trend toward a reduction in intensive care unit transfer for sepsis (OR 0.33; P =.10).

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In addition, the researchers found an overall shift in the percentage of levofloxacin-resistant gram-negative organisms isolated from the blood cultures of patients who received levofloxacin prophylaxis. However, the absolute increase was small: 2 isolates were reported in the baseline group compared with 4 in the levofloxacin group.

The researchers concluded that further studies are warranted to identify which individual patient factors and patient groups may be at highest risk for developing CLABSIs and could benefit most from antibiotic prophylaxis.

Reference

1. Ziegler M, Landsburg D, Pegues D, et al. Fluoroquinolone prophylaxis is highly effective for the prevention of central line-associated bloodstream infections in autologous stem cell transplant patients [published online November 24, 2018]. Biol Blood Marrow Transplant. doi: 10.1016/j.bbmt.2018.11.023