中性粒细胞异基因造血干细胞移植受者停止常规氟喹诺酮预防措施的影响:一项观察性研究。

IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Journal of Antimicrobial Chemotherapy Pub Date : 2024-10-14 DOI:10.1093/jac/dkae360
Anat Stern, Israel Henig, Maya Cohen, Ivan Gur, Oryan Henig, Tsila Zuckerman, Mical Paul
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引用次数: 0

摘要

背景:在抗生素耐药性不断上升的时代,氟喹诺酮类药物(FQ)对异基因造血干细胞移植(HSCT)患者的预防作用尚不确定:我们旨在评估血流感染(BSI)率、耐药性模式以及停止常规FQ预防性用药后患者的预后:回顾性纳入2017年至2020年首次接受造血干细胞移植的所有成人受者,并根据造血干细胞移植时间分为FQ组(2017年1月至2018年12月接受造血干细胞移植)或无FQ组(2019年1月至2020年12月)。主要结果是造血干细胞移植后第-7天至30天的革兰氏阴性(GN)BSI。研究期间与 BSI 之间的独立关联采用生存分析法进行评估,并对混杂因素进行调整:我们共纳入了 254 例患者,其中 FQ 组和无 FQ 组分别有 130 例(51%)和 124 例(49%)。与 FQ 组相比,无 FQ 组发生 GN BSI 的比例明显更高(21% 对 33%,P = 0.027),发生首次 GN BSI 的中位时间明显更短 [4 (IQR 1-8) 天对 6 (1-10) 天,P = 0.009]。经调整后,FQ 预防仍与较低的 GN BSI 危险相关(危险比 0.57,95% CI 0.34-0.93)。有82例GN BSI进行了FQ药敏试验。FQ 组中耐 FQ 的 GN BSI 例数更多(68.9% 对 41.6%,P = 0.021)。在30天死亡率、首次发热性中性粒细胞减少时间和首次使用广谱抗生素时间方面,两组间无明显差异(P不显著):结论:即使在FQ耐药率较高的情况下,FQ预防也能减少HSCT术后早期的GN BSI,预防后FQ耐药率>60%。
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Impact of discontinuing routine fluoroquinolone prophylaxis in neutropenic allogeneic haematopoietic stem cell transplant recipients: an observational study.

Background: Uncertainty exists as to the role of fluoroquinolone (FQ) prophylaxis for patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) in the era of rising antibiotic resistance.

Objectives: We aimed to evaluate rates of bloodstream infections (BSI), resistance patterns and outcomes of patients after discontinuing routine FQ prophylaxis administration.

Methods: All adult recipients of first HSCT from 2017 to 2020 were retrospectively included and classified according to time of HSCT as FQ group (HSCT January 2017-December 2018) or no FQ group (January 2019-December 2020). The primary outcome was Gram-negative (GN) BSI from day -7 to 30 days post-HSCT. The independent association between the study period and BSI was assessed using survival analysis, and adjusting for confounders.

Results: We included 254 patients, 130 (51%) and 124 (49%) in the FQ and no FQ groups, respectively. Compared to the FQ group, no FQ had significantly more GN BSI (21% versus 33%, P = 0.027) and the median time to first GN BSI was significantly shorter [4 (IQR 1-8) days versus 6 (1-10) days, P = 0.009]. Following adjustment, FQ prophylaxis remained associated with lower hazard for GN BSI (hazard ratio 0.57, 95% CI 0.34-0.93). Eighty-two GN BSI episodes had FQ susceptibility testing. More GN BSI episodes were FQ resistant in the FQ group (68.9% versus 41.6%, P = 0.021). No significant difference was found for 30-day mortality, time to first febrile neutropenia and time to first broad-spectrum antibiotics between the groups (P was not significant).

Conclusions: FQ prophylaxis is associated with fewer GN BSI in the early post-HSCT period even in high FQ resistance settings, with FQ resistance rates reaching >60% following prophylaxis.

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来源期刊
CiteScore
9.20
自引率
5.80%
发文量
423
审稿时长
2-4 weeks
期刊介绍: The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
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