scholarly journals Epidemiology of bacteremia after autologous hematopoietic stem cell transplantation in the absence of antibiotic prophylaxis

2018 ◽  
Vol 12 (02.1) ◽  
pp. 10S
Author(s):  
Rima Moghnieh ◽  
Anas Mugharbil ◽  
Ali Youssef ◽  
Tamima Jisr ◽  
Hani Tamim ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Central Line ◽  
Antibacterial Prophylaxis ◽  
Gram Positive ◽  
Hematopoietic Stem ◽  
Gram Negative

Introduction: Bacterial infections are frequent complications occurring after autologous hematopoietic stem-cell transplantation (AHSCT). Herein, we identified the bacterial ecology and its antibiogram in AHSCT patients. We assessed the incidence, contributing factors and outcome of prolonged neutropenia and bacteremia post-AHSCT in the absence of antibacterial prophylaxis. Methodology: This is a retrospective chart review of 190 adult patients who underwent AHSCT for lymphoma and multiple myeloma, between 2005 and 2015 at a Lebanese hospital. Results: Most of the isolated bacteria originated from urine (49%) followed by blood (30%) and were mainly Gram-negative (70%). Fluoroquinolone susceptibility was 57% among Gram-negative and Gram-positive isolates. Bacteremia was documented in 12.6% of the patients, with a predominant gram-negative etiology having 95% susceptibility to fluoroquinolones. The duration of neutropenia, < or > 7 days, did not affect the incidence of bacteremia (11% vs. 14% respectively, p = 0.17). Patients with lymphoma were more likely to have prolonged neutropenia compared to those with myeloma (p < 0.0001). The use of a central line and the development of central-line infections were significantly higher in Gram-positive bacteremia (p = 0.03, p = 0.008 respectively). Mucositis occurred more in Gram-negative bacteremia (p = 0.02). Total mortality rate was 3.7% in the whole population and that attributed to bacteremia was 12.5% in the bacteremia subgroup. Bacteremia was a predictor for mechanical ventilation (p = 0.003), septic shock and mortality (p = 0.025). Conclusion: Since organisms causing bacteremia were still highly susceptible to fluoroquinolones and that the duration of neutropenia post-AHSCT didn't affect bacteremia, we concluded that fluoroquinolone prophylaxis is still valid yet, with close monitoring of resistance.

Safety and Tolerability of Anti-Bacterial Prophylaxis during the Post-Engraftment Phase after Myeloablative Hematopoietic Stem Cell Transplantation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5093-5093
Author(s):  
Brandon Hayes-Lattin ◽  
Joseph Bubalo ◽  
Adam Dunn ◽  
Nan Subbiah ◽  
Bryon Allen ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Bacterial Infection ◽  
Cell Transplantation ◽  
Bacterial Infections ◽  
Antibacterial Prophylaxis ◽  
Study Medication ◽  
Hematopoietic Stem ◽  
Gram Negative

Abstract Background: Bacterial infections, including infections with Gram-negative organisms, frequently complicate the post-engraftment phase after myeloablative allogeneic hematopoietic stem cell transplantation. In this pilot study, we investigated the safety and tolerability of administering antibacterial prophylaxis from the time of engraftment (absolute neutrophil count of >1500/mm3 for 2 days) through day +100. Moxifloxacin was chosen for its broad spectrum of bacterial coverage and for its ability to target both bacterial topoisomerase IV and DNA gyrase, limiting the development of antimicrobial resistance. Methods: Twenty-three patients with engraftment after allogeneic transplantation at OHSU received moxifloxacin 400 mg po daily upon discontinuation of any antibiotics used for the treatment of pre-enrollment bacterial infection. Rates of bacterial infection, bacteremia, and colonization were recorded. Comparisons were made with a cohort of 60 consecutive patients undergoing myeloablative transplantation at OHSU without similar antibacterial prophylaxis from 2001–2002. Results: The median duration of moxifloxacin prophylaxis was 77 days (range 7–87). Five patients had dose interruptions due to nausea associated with graft-versus-host disease and two patients elected not to restart study medication. Only 3 patients had dose interruptions during empiric antibiotic therapy for possible bacterial infection. Overall, moxifloxacin was well tolerated in this patient population, with 5 episodes of grade 3/4 toxicity felt possibly related to study drug (2 orthostatic hypotension in one patient, 2 nausea, and 1 hypertension). Five patients had episodes of transaminitis which were unlikely to be due to study medication, and which responded to discontinuation of antifungal therapy (4) or to treatment of liver GVHD (1). No cardiac arrhythmias or tendonopathy were observed. Compared to historic controls, a marked decrease in post-engraftment phase bacterial infections was observed. The control cohort, 16 patients experienced 17 episodes of Gram-negative and 22 patients had 25 episodes of symptomatic Gram-positive infections during the post-engraftment phase without prophylaxis. In contrast with moxifloxacin prophylaxis, 2 patients experienced 3 Gram-negative infections (χ2, p=0.079), 1 patient had an anaerobic infection, and 7 patients had 9 symptomatic Gram-positive infections. Conclusions: Prophylactic moxifloxacin dosed throughout the post-engraftment phase has been well tolerated, safe, and associated with a fewer bacterial infections compared to historic controls. The efficacy of this prophylaxis strategy will best be determined in a planned randomized, placebo-controlled trial.

scholarly journals 574. De-escalation of Broad Spectrum Antibiotics during Cytokine Release Syndrome with Haploidentical Hematopoietic Stem Cell Transplantation

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S352-S352
Author(s):  
Molly Schiffer ◽  
Sarah Perreault ◽  
Dayna McManus ◽  
Francine Foss ◽  
Lohith Gowda ◽  
...  
Keyword(s):  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Broad Spectrum ◽  
Antibacterial Prophylaxis ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Hematopoietic Stem

Abstract Background Fever is a common component of cytokine release syndrome (CRS) occurring in 90% of patients undergoing haploidentical hematopoietic stem cell transplantation (Haplo-HSCT). Fevers typically occur between the stem cell infusion (Day 0) and initiation of post-transplant cyclophosphamide and are often confused with febrile neutropenia (FN). Due to longer time to engraftment in Haplo-HSCT, CRS/FN exposes patients to prolonged courses of empiric broad spectrum antibiotic (BSA) therapy increasing the risk for multi-drug resistant organisms. Recently, at Yale New Haven Health, our practice has changed to now recommend antibiotic de-escalation to prophylaxis after 7 days of BSA if no infection is identified. The objective of this study was to assess the incidence of breakthrough infections with the de-escalation of BSA in CRS/FN. Secondary endpoints include rate of FN, rate of de-escalation, rate of recurrent fevers, duration of BSA, and positive blood culture data. Methods The patient population included those undergoing Haplo-HSCT between July 2016 and February 2020 and who developed CRS/FN between Day 0 and Day +5. Patients were excluded if they had prolonged hospitalization due to non-infectious complications or engraftment failure. Bacteremia was defined using NHSN definitions. Results Of the 53 Haplo-HSCTs assessed, 43 experienced CRS/FN. Thirty-five Haplo-HSCT (81%) with CRS/FN had negative cultures and 23 (66%) of these were de-escalated back to antibacterial prophylaxis. The median duration of BSA in the de-escalated group was 7 days (range 5–13) compared to 16.5 days range (13–21) in the non-de-escalated group (p&lt; 0.001). Among those de-escalated, 7 (30%) had recurrent fever occurring at a median of 4 days (range 2–14) and were placed back on BSA. Two Haplo-HSCT (9%) that had fever after de-escalation developed a breakthrough bacteremia. No Haplo-HSCT after de-escalation had fever or re-admission for bacteremia 30 days after engraftment. Four Haplo-HSCT (9%) with CRS/FN had positive blood cultures; however, three (7%) were still able to be de-escalated from BSA to narrower agents based on susceptibilities. Conclusion De-escalation of BSA in FN/CRS in Haplo-HSCT patients reduced unnecessary, prolonged antibiotic exposure with a low incidence of breakthrough infections. Disclosures All Authors: No reported disclosures

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