Stopping antibacterial prophylaxis in pediatric allogeneic hematopoietic cell transplantation: An internal audit
Nina Wintjes1, Katja Krämer1, Hedwig Kolve1
1Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Pediatric Hematology and Oncology, University Children´s Hospital Münster, Münster, Germany.
Insights
Stopping routine antibacterial prophylaxis in pediatric hematopoietic stem cell transplantation (HSCT) did not increase fever or bacterial infections. This approach reduced overall antibiotic use while maintaining non-inferior survival rates in children undergoing HSCT.
Area of Science:
- Pediatric Hematology
- Infectious Disease
- Transplantation Immunology
Background:
- Antibacterial prophylaxis in pediatric allogeneic hematopoietic cell transplantation (HCT) is debated and not universally recommended.
- International guidelines do not support routine antibacterial prophylaxis for these patients.
- This study evaluates outcomes after discontinuing routine prophylaxis at a European pediatric transplant center.
Purpose of the Study:
- To analyze posttransplant outcomes in pediatric allogeneic HCT patients after stopping routine antibacterial prophylaxis.
- To determine the impact of discontinuing prophylaxis on survival, fever, and bacterial infections.
- To assess changes in overall antibiotic use and the incidence of resistant organisms.
Main Methods:
- A single-center retrospective audit of pediatric allogeneic HCT patients from 2011-2020.
- Comparison of outcomes before (≤2014) and after (≥2015) stopping routine prophylaxis (penicillin, metronidazole, ciprofloxacin).
- Primary endpoint: overall survival until first hospital discharge. Secondary endpoints: fever, bacterial infections, and duration of antibacterial agents.
Main Results:
- 257 HCT procedures in 249 patients were analyzed; 104 before and 153 after stopping prophylaxis.
- Overall survival until discharge was 90.4% (before) vs. 96.1% (after), p=.06.
- No significant differences in fever (92.3% vs. 94.1%) or bacterial infections (34.6% vs. 25.5%). Median antibacterial agent days decreased significantly (39 vs. 34, p=.002).
Conclusions:
- Discontinuation of routine antibacterial prophylaxis in pediatric HCT did not negatively impact fever, bacterial infections, or GVHD.
- Overall antibiotic use was significantly reduced.
- Survival remained non-inferior compared to the historical control cohort that received prophylaxis.
Background:
Antibacterial prophylaxis in children and adolescents undergoing allogeneic hematopoietic cell transplantation (HCT) is controversial and not recommended by international guidelines. We analyzed relevant posttransplant outcomes following discontinuation of antibacterial prophylaxis at a major European pediatric transplant center.
Methods:
The single-center retrospective audit included all pediatric allogeneic HCT patients (pts) transplanted between 2011 and 2020 before (≤2014) and after (≥2015) stopping routine antibacterial prophylaxis with penicillin, metronidazole, and ciprofloxacin upon start of the conditioning regimen. The primary endpoint was overall survival until the first hospital discharge. Secondary endpoints included the occurrence of fever; bacterial infections; and cumulative days with antibacterial agents until discharge.
Results:
A total of 257 HCT procedures were performed in 249 pts (median age: 10 years, range, 0.2-22.5) for leukemia/lymphoma (n = 150) and nonmalignant disorders (n = 107). Of these, 104 procedures were performed before (cohort 1) and 153 after (cohort 2) stopping prophylaxis. Overall survival until discharge was 90.4% in cohort 1 and 96.1% in cohort 2 (p = .06). No differences were observed in the occurrence of fever (92.3 vs. 94.1%; p = .57) and bacterial infections (34.6 vs. 25.5%; p = .11). The median number of days on antibacterial agents was significantly lower in cohort 2 (39 vs. 34; p = .002). Detection rates of resistant organisms were overall low.
Conclusion:
In this single-center audit, the stop of routine antibacterial prophylaxis had no effect on the occurrence of fever, bacterial infections, resistant organisms, and GVHD. Overall antibiotic use was significantly reduced, and survival was noninferior to the historical control cohort.
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