The effect of ciprofloxacin prophylaxis during haematopoietic cell transplantation on infection episodes, exposure to treatment antimicrobials and antimicrobial resistance: a single-centre retrospective cohort study

Ioannis Baltas; Konstantinos Kavallieros; Giannis Konstantinou; Eirini Koutoumanou; Malick M Gibani; Mark Gilchrist; Frances Davies; Jiri Pavlu

doi:10.1093/jacamr/dlae010

The effect of ciprofloxacin prophylaxis during haematopoietic cell transplantation on infection episodes, exposure to treatment antimicrobials and antimicrobial resistance: a single-centre retrospective cohort study

JAC Antimicrob Resist. 2024 Feb 1;6(1):dlae010. doi: 10.1093/jacamr/dlae010. eCollection 2024 Feb.

Authors

Ioannis Baltas^{1

2}, Konstantinos Kavallieros³, Giannis Konstantinou³, Eirini Koutoumanou⁴, Malick M Gibani⁵, Mark Gilchrist⁵, Frances Davies^{5

6}, Jiri Pavlu^{2

3}

Affiliations

¹ Department of Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, UK.
² Department of Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
³ Faculty of Medicine, Imperial College London, London, UK.
⁴ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK.
⁵ Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK.
⁶ Department of Infectious Disease, Imperial College NHS Healthcare Trust, St Mary's Hospital, London, UK.

Abstract

Objectives: Fluroquinolone prophylaxis during haematopoietic cell transplantation (HCT) remains contentious. We aimed to determine its effectiveness and association with exposure to treatment antimicrobials and antimicrobial resistance.

Methods: All admission episodes for HCT (N = 400 , 372 unique patients) in a tertiary centre between January 2020 and December 2022 were studied. Allogeneic HCT (allo-HCT) recipients received prophylaxis with ciprofloxacin during chemotherapy-induced neutropenia, while autologous HCT (auto-HCT) recipients did not.

Results: Allo-HCT was performed for 43.3% (173/400) of patients, auto-HCT for 56.7% (227/400). Allo-HCT was associated with an average of 1.01 fewer infection episodes per 100 admission days (95% CI 0.62-1.40, P < 0.001) compared with auto-HCT. In allo-HCT, the total exposure to all antimicrobials was higher [+24.8 days of therapy (DOT)/100 admission days, P < 0.001], as was exposure to ciprofloxacin (+40.5 DOT/100 admission days, P < 0.001). By contrast, exposure to meropenem (-4.5 DOT/100 admission days, P = 0.02), piperacillin/tazobactam (-5.2 DOT/100 admission days, P < 0.001), aminoglycosides (-4.5 DOT/100 admission days, P < 0.001) and glycopeptides (-6.4 DOT/100 admission days, P < 0.001) was reduced. Enterobacteriaceae isolated during allo-HCT were more resistant to ciprofloxacin (65.5%, 19/29 versus 6.1%, 2/33, P < 0001), ceftriaxone (65.5%, 19/29 versus 9.1%, 3/33, P < 0.001), other antimicrobial classes. Vancomycin-resistant enterococci were more common in allo-HCT recipients (11%, 19/173 versus 0.9%, 2/227, P < 0.001). Inpatient mortality during allo- and auto-HCT was 9.8% (17/173) and 0.4% (1/227). respectively (P < 0.001).

Conclusions: Ciprofloxacin prophylaxis in allo-HCT was associated with fewer infection episodes and reduced exposure to treatment antimicrobials. Mortality in auto-HCT remained low. A significant burden of antimicrobial resistance was detected in allo-HCT recipients.

Grants and funding

WT_/Wellcome Trust/United Kingdom