Discontinuing Ciprofloxacin Prophylaxis in Allogeneic Stem Cell Transplantation Does Not Result in Inferior Outcomes

Area of Science:

• Hematology
• Infectious Diseases
• Pharmacology

Background:

• The use of fluoroquinolone (FQ) prophylaxis in neutropenia post allogeneic stem cell transplant (alloSCT) is debated due to resistance and microbiome concerns.
• Limited data exist comparing alloSCT outcomes before and after FQ discontinuation.

Purpose of the Study:

• To evaluate the impact of discontinuing routine ciprofloxacin prophylaxis on bacterial bloodstream infections (BSI), graft-versus-host disease (GvHD), and overall survival (OS).
• To assess outcomes in adult alloSCT recipients following an institutional policy change regarding FQ prophylaxis.

Main Methods:

• Retrospective analysis of 292 adult alloSCT recipients.
• Comparison between 116 patients receiving ciprofloxacin prophylaxis and 176 patients not receiving it during neutropenia.
• Analysis of bacterial bloodstream infections (BSI), GvHD incidence and severity, and overall survival (OS).

Main Results:

• Overall BSI rates were similar between groups (42% vs. 48%, P=.40).
• FQ prophylaxis shifted BSI pathogens towards gram-positive organisms, while non-prophylaxis was associated with more gram-negative and polymicrobial infections.
• No significant independent association was found between FQ prophylaxis and BSI, grade III-IV acute GvHD, or OS in multivariable analysis.
• Cryopreserved grafts were the strongest predictor of severe acute GvHD (aOR 3.49, P<.001).

Conclusions:

• Discontinuation of ciprofloxacin prophylaxis in inpatient alloSCT did not lead to increased BSI rates, GvHD, or reduced survival.
• FQ prophylaxis altered the pathogen spectrum without clear clinical benefit, supporting antibiotic stewardship strategies.
• Routine FQ prophylaxis can be forgone in inpatient alloSCT settings with strong surveillance and prompt empiric treatment.