Ciprofloxacin prophylaxis in high risk neutropenic patients: effects on outcomes, antimicrobial therapy and resistance
Ciprofloxacin prophylaxis in high risk neutropenic patients: effects on outcomes, antimicrobial therapy and resistance
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DOI：
10.1186/1471-2334-13-356
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发表时间：
2013-07-31
影响因子：
3.7
通讯作者：
Nucci, Marcio
中科院分区：
文献类型：
--
作者：
Garnica, Marcia;Nouer, Simone A.;Nucci, Marcio
背景资料：在高危血小板减少症患者中使用喹诺酮预防被认为是标准治疗，但耐药性的发展是一个问题。以前的研究主要集中在喹诺酮类药物耐药性的患者接受预防，很少有数据报告其对医院的微生物epidemiology.Methods的影响：我们分析了一个队列的329例化疗诱导的中性粒细胞减少症的成年人，并比较了两个时期：2005年（第1阶段，无预防，n=110）和2006-2008年（第2阶段，环丙沙星预防，n=219）。分析的结果包括发热性中性粒细胞减少症、菌血症、抗生素治疗和住院时间、对环丙沙星的耐药性和超广谱β-内酰胺酶（ESBL）的产生。我们分析了（按患者-天），以及其他患者（血小板减少症和非血小板减少症，11，975例患者-天），考虑到医院的一般耐药模式。喹诺酮预防（阶段2）导致发热性中性粒细胞减少症的发作减少（159/219 [73%] vs. 102/110 [93%]，卡方检验18.09，p=0.00002）和菌血症（49/219 [22] vs. 36/110 [33%]，卡方检验4.10，p=0.04），抗生素治疗持续时间较短（p=0.0002）和住院（p=0.002），但碳青霉烯类药物的使用频率更高（79/219 [36%] vs. 15/110 [14%]，卡方18.06，p=0.0002）。此外，第2阶段与较高的喹诺酮类耐药率相关（6.77 vs. 3.02/1000患者-天，p=0.03）。两个时间段的产ESBL肠杆菌检出率在接受喹诺酮类药物预防的患者中略高（1.27 vs. 0.38/1，000患者-天，p=0.26）以及血液科总体（1.59 vs. 0.53/1，000患者-天，p=0.08），但在整个医院保持稳定（0.53 vs. 0.56/1，000患者-天，p=0.74）。环丙沙星预防治疗对高危血小板减少症患者有益，但观察到碳青霉烯类的处方和分离株的抗菌药物耐药性模式的重要修改。在决定对高危血小板减少症患者进行喹诺酮类预防治疗时，必须考虑到医院或病房生态的重要性。
Background: The use of quinolone prophylaxis in high-risk neutropenic patients is considered standard of care but the development of resistance is a concern. Previous studies have focused mainly on quinolone resistance among patients receiving prophylaxis, with very few data reporting its impact on the hospital microbial epidemiology.Methods: We analyzed a cohort of 329 episodes of chemotherapy-induced neutropenia in adults, and compared two periods: 2005 (period 1, no prophylaxis, n=110) and 2006-2008 (period 2, ciprofloxacin prophylaxis, n=219). Outcomes analyzed were the frequency of febrile neutropenia, bacteremia, duration of antibiotic therapy and hospitalization, and antimicrobial resistance to ciprofloxacin and extended-spectrum beta-lactamase [ESBL] production. We analyzed resistance rates (by patients-day) in the cohort, as well as in other patients (neutropenic and non-neutropenic, 11,975 patients-day) admitted to the hematology unit in the same period, taking into consideration the general resistance patterns in the hospital.Results: Quinolone prophylaxis (period 2) resulted in fewer episodes of febrile neutropenia (159/219 [73%] vs. 102/110 [93%], Chi-square 18.09, p=0.00002), and bacteremia (49/219 [22] vs. 36/110 [33%], Chi-square 4.10, p=0.04), shorter duration of antibiotic therapy (p=0.0002) and hospitalization (p=0.002), but more frequent use of carbapenems (79/219 [36%] vs. 15/110 [14%], Chi-square 18.06, p=0.0002). In addition, period 2 was associated with higher rates of quinolone resistance (6.77 vs. 3.02 per 1,000 patients-day, p=0.03). The rate of ESBL-producing enterobacteria in the two periods was slightly higher in patients receiving quinolone prophylaxis (1.27 vs. 0.38 per 1,000 patients-day, p=0.26) as well as in the hematology unit overall (1.59 vs. 0.53 per 1,000 patients-day, p=0.08), but remained stable in the whole hospital (0.53 vs. 0.56 per 1,000 patients-day, p=0.74).Conclusions: Ciprofloxacin prophylaxis was beneficial in high risk neutropenic patients, but important modifications in the prescription of carbapenems and on antimicrobial resistance patterns of isolates were observed. The importance of hospital or ward ecology must be taken into account when deciding for quinolone prophylaxis in high-risk neutropenic patients.