Impact of multidrug resistant bloodstream infection burden, prophylactic levofloxacin and rectal swab practice on children with high-risk leukemias
Abstract
OBJECTIVE: Aim: To determine the prevalence of multidrug-resistant rectal colonization and bloodstream infection in children with high-risk leukemia receiving levofloxacin prophylaxis, to assess changes in fluoroquinolone susceptibility across chemotherapy cycles, and to examine concordance between rectal surveillance cultures and bloodstream infection.
PATIENTS AND METHODS: Materials and Methods: This retrospective cohort included 82 children aged 18 years or younger with acute myeloid leukemia or relapsed acute lymphoblastic leukemia treated with intensive chemotherapy and levofloxacin prophylaxis. Rectal swabs were obtained during febrile neutropenia when available, blood cultures were obtained for all febrile neutropenia episodes, and empirical meropenem was modified according to culture results. Multidrug resistance was classified according to published consensus criteria.
RESULTS: Results: Median age was 10 years, 67.1% were male, and 82.9% had acute myeloid leukemia. Febrile neutropenia occurred in 89.3% of chemotherapy cycles. Rectal colonization was dominated by multidrug-resistant Klebsiella species and multidrug-resistant Escherichia coli. Bloodstream infection was dominated by multidrug-resistant Klebsiella pneumoniae and multidrug-resistant Escherichia coli. Fluoroquinolone susceptibility was low in both rectal isolates (16%) and bloodstream isolates (11.8%) and decreased further across successive cycles. Mortality was associated with multidrug-resistant…
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: 82 participants or records.
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