Comparison of the rates of Clostridium difficile and bacteremia after delaying fluoroquinolone prophylaxis from day 0 to day +3 post autologous stem cell transplantation
Abstract
Prophylactic fluoroquinolones are routinely administered after stem cell transplantation (SCT) to prevent bacterial infection; however, fluoroquinolones may increase the risk of Clostridium difficile infection, particularly in immunocompromised patients. This study is designed to evaluate the effect of a delay by 3 days in fluoroquinolone prophylaxis after autologous SCT (ASCT) on the rates of C. difficile infection and bacteremia. A single-center retrospective cohort study was performed in 118 patients who received levofloxacin prophylaxis following ASCT at our institution between November 2014 and October 2015. In efforts to reduce the rate of C. difficile, initiation of levofloxacin prophylaxis was delayed from day 0 to day +3 of SCT beginning April 30, 2015. The incidence of C. difficile infection and of bacteremia in patients who initiated levofloxacin on day 0 was compared with those who started prophylaxis on day +3. We found no difference in the rates of C. difficile (7.9% vs 5.5%, P=.593) and bacteremia (7.9% vs 3.6%, P=.323) in patients who initiated levofloxacin on day 0 compared with those who initiated prophylaxis on day +3. Delaying the initiation of levofloxacin prophylaxis by 3 days post ASCT showed no difference in the incidence of C. difficile or bacteremia. Future studies are warranted to show feasibility of delaying the initiation of antibiotic prophylaxis until neutropenia post ASCT, to further minimize the duration of antibiotic exposure.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 118 participants or records.
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