The impact of a change in antibacterial prophylaxis from ceftazidime to levofloxacin in allogeneic hematopoietic cell transplantation.
The impact of a change in antibacterial prophylaxis from ceftazidime to levofloxacin in allogeneic hematopoietic cell transplantation.
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DOI：
10.1038/bmt.2009.216
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发表时间：
2010-04
影响因子：
4.8
通讯作者：
Fredricks, D. N.
中科院分区：
文献类型：
--
作者：
Guthrie, K. A.;Yong, M.;Frieze, D.;Corey, L.;Fredricks, D. N.
在清髓性造血干细胞（HCT）移植的初始阶段，抗生素预防已经使用了二十多年。然而，就成本和临床有效性而言的最佳方案尚不清楚。我们回顾性比较了在接受清髓性预处理的患者中，抗生素预防实践从头孢他啶（n=216例HCT患者，2000 - 2002年）到左氧氟沙星（n=219例患者，2002 - 2005年8月）的变化对临床和微生物学的影响。左氧氟沙星预防与发热和中性粒细胞减少时抗生素的变化相关，但这种策略与任何不良结局无关。接受左氧氟沙星治疗的患者显著菌血症发生率低于接受头孢他啶治疗的患者（第100天，19.2% vs. 29.6%，p=0.02）。左氧氟沙星的使用与较低的抗生素采购成本相关。左氧氟沙星预防对生存率、抗生素耐药性的出现、粪便中艰难梭菌抗原的检测、草绿色链球菌菌血症或假单胞菌感染的发生率没有有害影响。与头孢他啶组相比，左氧氟沙星组的尿路感染、伤口感染和细菌性呼吸道感染的发生率有降低的趋势，但这些差异无统计学意义。这些数据支持使用左氧氟沙星作为预防性清髓异基因HCT时，采用。
Antibiotic prophylaxis has been utilized during the initial phases of myeloablative hematopoietic stem cell (HCT) transplantation for over two decades. However, the optimal regimen in terms of both cost and clinical effectiveness is unclear. We retrospectively compared the clinical and microbiological impact of a change in antibiotic prophylaxis practice from ceftazidime (n=216 patients with HCT in 2000 – 2002) to levofloxacin (n=219 patients, August 2002 – 2005) in patients receiving myeloablative conditioning. Levofloxacin prophylaxis was associated with fever and a change in antibiotic during neutropenia, but this strategy was not associated with any adverse outcomes. Patients receiving levofloxacin had lower rates of significant bacteremia than those receiving ceftazidime (day 100, 19.2% vs. 29.6%, p=0.02). Use of levofloxacin was associated with lower antibiotic acquisition costs. There was no deleterious impact from levofloxacin prophylaxis on survival, emergence of antibiotic resistance, detection of Clostridium difficile antigen in stool, incidence of viridans group streptococcal bacteremia or Pseudomonas infections. There was a trend towards lower rates of bacteruria, wound and bacterial respiratory infections in the levofloxacin than in the ceftazidime group, but these differences were not statistically significant. These data support the use of levofloxacin as prophylaxis in myeloablative allogeneic HCT when prophylaxis is employed.
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