Characteristics of gram-negative bacteremia during febrile neutropenia among allogeneic hematopoietic stem cell transpla
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ORIGINAL ARTICLE
Characteristics of gram-negative bacteremia during febrile neutropenia among allogeneic hematopoietic stem cell transplant recipients on levofloxacin prophylaxis Sho Ogura 1 & Muneyoshi Kimura 1 & Shinsuke Takagi 2 & Takashi Mitsuki 2 & Mitsuhiro Yuasa 2 & Kosei Kageyama 2 & Daisuke Kaji 2 & Aya Nishida 2 & Yuki Taya 2 & Kazuya Ishiwata 2 & Hisashi Yamamoto 2 & Yuki Asano-Mori 2 & Go Yamamoto 2 & Naoyuki Uchida 2 & Atsushi Wake 2 & Shuichi Taniguchi 2 & Hideki Araoka 1 Received: 23 September 2020 / Accepted: 30 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The aim of this study is to clarify the characteristics of gram-negative bacteremia (GNB), including extended-spectrum βlactamase (ESBL)-producing pathogens, among allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients on levofloxacin (LVFX) prophylaxis. A retrospective analysis on GNB at the first episode of febrile neutropenia (FN) was conducted among allo-HSCT recipients (age ≥ 20 years) on 500 mg/day of oral LVFX prophylaxis. Epidemiological and microbiological features of GNB were investigated and compared between the inappropriate and appropriate empiric therapy groups. In total, FN occurred in 414 allo-HSCT cases, and bacteremia at the first episode of FN occurred in 169 cases. Overall, 29 GNB cases were documented, and the causative organisms identified were Escherichia coli in 21 cases (including 10 ESBLs), Klebsiella pneumoniae in 2, Pseudomonas aeruginosa in 2, and other in 4. The crude 30-day mortality rate was not significantly different among cases of GNB (6.9%), gram-positive bacteremia (GPB) (7.1%), or nonbacteremia (5.4%; P = 0.78). Cefepime (CFPM) was administered in all cases in the inappropriate empiric therapy group, and all causative organisms were ESBL-producing E. coli (ESBL-EC). All patients in the inappropriate empiric therapy group had a low Pitt bacteremia score (≤ 2). Thirty-day mortality did not differ significantly between the inappropriate and appropriate empiric therapy groups (1/10 vs. 1/15, P = 0.61). In conclusion, GNB was not a significant cause of death. In LVFX breakthrough ESBL-EC bacteremia among allo-HSCT recipients, the administration of CFPM as empiric therapy did not lead to significantly poor prognosis. Empiric CFPM administration might be an acceptable strategy. Keywords Febrile neutropenia . Allogeneic hematopoietic stem cell transplantation . Levofloxacin prophylaxis . Gram-negative bacteremia . Extended-spectrum β-lactamase-producing E. coli
Introduction Febrile neutropenia (FN) is the severe adverse events that can occur during chemotherapy for cancer [1]. In allogeneic
* Muneyoshi Kimura [email protected] 1
Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
2
Department of Hematology, Toranomon Hospital, Tokyo, Japan
hematopoietic stem cell transplantation (allo-HSCT) recipients especially, bloodstream infection (BSI) during FN remains a severe and life-threatening problem [
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