Levofloxacin prophylaxis omission in acute myeloid leukemia during post induction aplasia: a single center study

Abstract

Background and objectives: acute myeloid leukemia (AML) patients are at high risk of infections during post induction neutropenia. Recently, the role of antibacterial prophylaxis has been reconsidered due to concerns about the emergence of multi-resistant pathogens. Aim of the present study was to evaluate the impact of prophylaxis omission on the rate of induction death (primary endpoint), neutropenic fevers, bloodstream infections (BSIs), resistant pathogens BSIs and septic shocks (secondary endpoints). Methods: we performed a retrospective single center study including 373 AML patients treated with intensive induction chemotherapy, divided in two groups according to levofloxacin prophylaxis given (group A, gA) or not (group B, gB). Results: neutropenic fever was observed in 91% of patients in gA and 97% in gB (OR 0.35, IC95% 0.08 – 1.52, p=0162).The rate of BSIs was 27% in gA compared to 34% in gB (OR 0.69, 0.38 – 1.25, p=0.222). Induction death rate was 5% in gA and 3% in gB (OR 1.50, 0.34 – 6.70, p=0.284). Fluoroquinolones (FQ) resistant pathogens were responsible for 59% of total BSIs in gA and 22% in gB (OR 5.07, 1.87 – 13.73, p=0.001); gram-negative BSIs due to multi-drug resistant organisms were 31% in gA and 36% in gB (OR 0.75, 0.15 – 3.70, p=0.727). Conclusions: levofloxacin prophylaxis omission was not associated with an increased risk of induction death. Cumulative incidence of neutropenic fever was higher in non-prophylaxis group, while no difference was observed for BSIs. In the prophylaxis group we observed a higher incidence of FQ resistant organisms.

Keywords

• acute myeloid leukemia
• levofloxacin prophylaxis
• bloodstream infections
• induction death
• antibiotic resistance