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Fluoroquinolone Prophylaxis Uncovers High Prevalence Rates of Fluoroquinolone-Resistant Enterobacterales Colonization

Chintan Patel1, Austin J Terlecky2, Melissa Baker1

  • 1John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA.

Cancers
|May 27, 2026
PubMed

Insights

Fluoroquinolone prophylaxis increases fluoroquinolone-resistant Enterobacterales colonization in multiple myeloma patients undergoing stem cell transplant. Pre-transplant screening can guide antibiotic strategies to prevent resistant bloodstream infections.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Microbiology

Background:

  • Autologous stem cell transplantation (aSCT) patients receive fluoroquinolone prophylaxis to prevent fever.
  • This prophylaxis increases the risk of bloodstream infections (BSI) caused by fluoroquinolone-resistant Enterobacterales (FRE).
  • The study focuses on multiple myeloma patients undergoing aSCT.

Purpose of the Study:

  • To prospectively detect the presence, gain, or loss of colonic FRE colonization.
  • To assess the impact of fluoroquinolone prophylaxis on FRE colonization.
  • To identify risk factors for FRE BSI in aSCT patients.

Main Methods:

  • Prospective cohort study involving patients with multiple myeloma undergoing aSCT.
  • Serial peri-anal swab sampling before aSCT, at discharge, and 12-16 weeks post-transplant.
  • Culture on selective media to detect and differentiate Enterobacterales, including FRE.

Main Results:

  • FRE colonization increased significantly from pre-transplant (19.7%) to discharge (29.6%) and remained elevated at 12-16 weeks (30.4%).
  • Overall, 41.0% of subjects were colonized with FRE at any time point.
  • 64.4% of FRE isolates expressed extended-spectrum beta-lactamase (ESBL). Three colonized subjects developed FRE BSI, with two isolates matching pre-transplant strains.

Conclusions:

  • Fluoroquinolone prophylaxis may promote expansion of undetected low-level FRE colonization, increasing BSI risk.
  • Pre-transplant FRE colonization screening is crucial for personalized antibiotic prophylaxis and empiric treatment.
  • Targeted screening can help mitigate the risk of BSI with fluoroquinolone-resistant and ESBL-producing Enterobacterales.
Keywords:
Enterobacteralesantibiotic prophylaxisautologous stem cell transplantationfluoroquinolone resistancemultiple myeloma

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