A Single Center Analysis of Peritransplant Antibiotic Prophylaxis for Patients Undergoing Hematopoietic Cell Transplantation

The use of prophylactic antibiotics during the peritransplant period is common in hematopoietic cell transplantation (HCT) in an effort to reduce the risk for bacterial bloodstream infections. However, evidence supporting improved outcomes with this practice is limited. Furthermore, there are potential consequences to antibiotic exposure, including increased risk for the development of antibiotic resistance and disruption of the intestinal microbiome. We reviewed our institutional experience in patients receiving peritransplant prophylaxis with ciprofloxacin (500 mg twice daily starting from Day -1 until neutrophil engraftment or escalation of therapy for treatment of febrile neutropenia or infection). We compared outcomes of 84 consecutive patients (auto-HCT: 39; allo-HCT: 45) undergoing first HCT who did not receive ciprofloxacin prophylaxis during a 6-month trial period with 204 consecutive patients (auto-HCT: 107; allo-HCT: 97) that received prophylaxis in the 6-month periods before and after the trial period. Patient and transplant characteristics are shown in Table 1. We found antibiotic prophylaxis to be associated with lower rates of bacterial bloodstream infections (auto-HCT: 5.6% vs 18%, p=0.023; allo-HCT: 14% vs 27%, p=0.072) as compared those not receiving antibiotic prophylaxis. Amongst patients undergoing allo-HCT, severe (grade 3-4) acute graft-versus-host disease was rare and there was no difference in the incidence between the groups (prophylaxis: 5.2% vs no prophylaxis: 8.9%, p=0.37). Additionally, there was no difference in 100-day non-relapse mortality (4.1% vs 4.4%, p=0.90) or 1-year overall survival (77% vs 71%, p=0.55) between allo-HCT patients receiving prophylactic antibiotics or not. In multivariate analysis, the use of antibiotic prophylaxis was associated with a decreased risk for bacterial bloodstream infections in auto-HCT recipients (HR 0.3, 95%CI 0.1-0.85, p=0.023) and allo-HCT recipients (HR 0.46, 95%CI 0.21-1.0, p=0.050). In conclusion, the use of prophylactic ciprofloxacin during the peritransplant period may protect against bacterial bloodstream infections. Prospective studies are needed to better characterize the benefits and consequences of antibiotic exposure in the peri- and early post-transplant period. The use of prophylactic antibiotics during the peritransplant period is common in hematopoietic cell transplantation (HCT) in an effort to reduce the risk for bacterial bloodstream infections. However, evidence supporting improved outcomes with this practice is limited. Furthermore, there are potential consequences to antibiotic exposure, including increased risk for the development of antibiotic resistance and disruption of the intestinal microbiome. We reviewed our institutional experience in patients receiving peritransplant prophylaxis with ciprofloxacin (500 mg twice daily starting from Day -1 until neutrophil engraftment or escalation of therapy for treatment of febrile neutropenia or infection). We compared outcomes of 84 consecutive patients (auto-HCT: 39; allo-HCT: 45) undergoing first HCT who did not receive ciprofloxacin prophylaxis during a 6-month trial period with 204 consecutive patients (auto-HCT: 107; allo-HCT: 97) that received prophylaxis in the 6-month periods before and after the trial period. Patient and transplant characteristics are shown in Table 1. We found antibiotic prophylaxis to be associated with lower rates of bacterial bloodstream infections (auto-HCT: 5.6% vs 18%, p=0.023; allo-HCT: 14% vs 27%, p=0.072) as compared those not receiving antibiotic prophylaxis. Amongst patients undergoing allo-HCT, severe (grade 3-4) acute graft-versus-host disease was rare and there was no difference in the incidence between the groups (prophylaxis: 5.2% vs no prophylaxis: 8.9%, p=0.37). Additionally, there was no difference in 100-day non-relapse mortality (4.1% vs 4.4%, p=0.90) or 1-year overall survival (77% vs 71%, p=0.55) between allo-HCT patients receiving prophylactic antibiotics or not. In multivariate analysis, the use of antibiotic prophylaxis was associated with a decreased risk for bacterial bloodstream infections in auto-HCT recipients (HR 0.3, 95%CI 0.1-0.85, p=0.023) and allo-HCT recipients (HR 0.46, 95%CI 0.21-1.0, p=0.050). In conclusion, the use of prophylactic ciprofloxacin during the peritransplant period may protect against bacterial bloodstream infections. Prospective studies are needed to better characterize the benefits and consequences of antibiotic exposure in the peri- and early post-transplant period. Figure 1.

Topic: Neutropenia and Cancer Infections
Subfield: Oncology
Field: Medicine
Domain: Health Sciences