Incidence rate of fluoroquinolone resistant gram-negative rod bacteremia among allogeneic hematopoietic cell transplant patients during an era of levofloxacin prophylaxis
Abstract
Background There are concerns that emerging resistance to fluoroquinolones (FQ) may be leading to increasing rates of gram-negative rod (GNR) bacteremia in hematopoietic cell transplant (HCT) recipients. We set out to describe time trends in the incidence rates (IR) of GNR bacteremia and FQ-resistant GNR bacteremia in HCT recipients during an era of levofloxacin prophylaxis. Methods We conducted a longitudinal retrospective study of adults undergoing allogeneic HCT between 2003 and 2012 at the Seattle Cancer Care Alliance (SCCA). Annual trends in the IRs of GNR bacteremia and FQ-resistant GNR bacteremia through 100 days post-transplant were assessed using Poisson regression. Cox proportional hazards regression was used to compare 30-day mortality between patients with FQ-resistant and those with FQ-sensitive GNR bacteremia. Results Of the 2306 patients included in this cohort, 280 (12.1%) had GNR bacteremia. The IRs of GNR bacteremia and FQ-resistant GNR bacteremia increased from 2003 to 2009 and decreased afterwards; however, the overall annual trends were not significant (Incidence rate ratio [IRR] =1.01; 95% confidence interval [CI]: 0.98, 1.05 and IRR=1.01; 95% CI: 0.95, 1.08, respectively). FQ-resistant GNR bacteremia was associated with increased mortality compared to FQ-sensitive GNR bacteremia, even after adjustment for underlying disease severity, conditioning regimen, and age at transplant (Hazard ratio=2.11, 95% CI: 1.06, 4.23). Conclusions On average, rates of…
How strong is the evidence?
Evidence Hub reads this as a clinical trial, 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: 2,306 participants or records.
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