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Levofloxacin Prophylaxis Versus no Prophylaxis in Acute Myeloid Leukemia During Post-Induction Aplasia: a Single
Irene Urbino1, Chiara Frairia1, Alessandro Busca2
1Department of Oncology, Division of Hematology, Città della Salute e della Scienza, Turin, Italy.
Background:
Acute myeloid leukemia (AML) patients are at high risk of infections during post-induction neutropenia. Recently, the role of antibacterial prophylaxis has been reconsidered due to concerns about the emergence of multi-resistant pathogens. The aim of the present study was to evaluate the impact of avoiding prophylaxis on the rate of induction death (primary endpoint), neutropenic fevers, bloodstream infections (BSIs), resistant pathogens BSIs and septic shocks (secondary endpoints).
Methods:
We performed a retrospective single-center study including 373 AML patients treated with intensive induction chemotherapy, divided into two groups according to levofloxacin prophylaxis given (group A, gA) or not (group B, gB).
Results:
Neutropenic fever was observed in 91% of patients in gA and 97% in gB (OR 0.35, IC95% 0.08 - 1.52, p=0162). The rate of BSIs was 27% in gA compared to 34% in gB (OR 0.69, 0.38 - 1.25, p=0.222). The induction death rate was 5% in gA and 3% in gB (OR 1.50, 0.34 - 6.70, p=0.284). Fluoroquinolones (FQ) resistant pathogens were responsible for 59% of total BSIs in gA and 22% in gB (OR 5.07, 1.87 - 13.73, p=0.001); gram-negative BSIs due to multi-drug resistant organisms were 31% in gA and 36% in gB (OR 0.75, 0.15 - 3.70, p=0.727).
Conclusions:
Despite its limitations (retrospective nature, single-center, different cohort size), the present study showed that avoiding levofloxacin prophylaxis was not associated with an increased risk of induction death. The cumulative incidence of neutropenic fever was higher in non-prophylaxis group, while no difference was observed for BSIs. In the prophylaxis group we observed a higher incidence of FQ-resistant organisms.
Insights
Avoiding antibacterial prophylaxis in acute myeloid leukemia (AML) patients did not increase induction death rates. However, it led to more neutropenic fevers but fewer fluoroquinolone-resistant infections.
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Oncology
Background:
- Acute myeloid leukemia (AML) patients face high infection risks during neutropenia.
- Concerns regarding multi-resistant pathogens have prompted reevaluation of antibacterial prophylaxis in AML.
- This study investigates the impact of discontinuing prophylaxis on key clinical outcomes.
Purpose of the Study:
- To evaluate the effect of avoiding levofloxacin prophylaxis on induction death rates in AML patients.
- To assess the impact on secondary endpoints including neutropenic fevers, bloodstream infections (BSIs), and resistant pathogen BSIs.
Main Methods:
- A retrospective, single-center study included 373 AML patients undergoing intensive induction chemotherapy.
- Patients were divided into two groups: those receiving levofloxacin prophylaxis (group A) and those not (group B).
Main Results:
- No significant difference in induction death rates between groups (5% in group A vs. 3% in group B).
- Higher incidence of neutropenic fever in the non-prophylaxis group (97% vs. 91%).
- A significantly higher proportion of BSIs were caused by fluoroquinolone-resistant pathogens in the prophylaxis group (59% vs. 22%).
Conclusions:
- Avoiding levofloxacin prophylaxis in AML patients was not associated with increased induction death.
- While neutropenic fever rates were higher without prophylaxis, bloodstream infections did not differ significantly.
- Antibacterial prophylaxis was linked to a higher incidence of fluoroquinolone-resistant organisms.
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