Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: two parallel patient cohorts treated in a single center
Michele Pohlen,
Julia Marx,
Alexander Mellmann,
Karsten Becker,
Rolf M. Mesters,
Jan-Henrik Mikesch,
Christoph Schliemann,
Georg Lenz,
Carsten Müller-Tidow,
Thomas Büchner,
Utz Krug,
Matthias Stelljes,
Helge Karch,
Georg Peters,
Hans U. Gerth,
Dennis Görlich,
Wolfgang E. Berdel
Affiliations
Michele Pohlen
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Julia Marx
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Alexander Mellmann
Institute of Hygiene, University Hospital Muenster, Germany
Karsten Becker
Institute of Medical Microbiology, University Hospital Muenster, Germany
Rolf M. Mesters
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Jan-Henrik Mikesch
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Christoph Schliemann
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Georg Lenz
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany;Translational Oncology, University Hospital Muenster, Germany;Cluster of Excellence EXC 1003, Cells in Motion, Germany
Carsten Müller-Tidow
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany;Department of Medicine IV, Hematology and Oncology, University Hospital Halle, Germany
Thomas Büchner
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Utz Krug
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany;Department of Medicine 3, Klinikum Leverkusen, Germany
Matthias Stelljes
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany
Helge Karch
Institute of Hygiene, University Hospital Muenster, Germany;Cluster of Excellence EXC 1003, Cells in Motion, Germany
Georg Peters
Institute of Medical Microbiology, University Hospital Muenster, Germany;Cluster of Excellence EXC 1003, Cells in Motion, Germany
Hans U. Gerth
Department of Medicine D, Nephrology and Rheumatology, University Hospital Muenster, Germany
Dennis Görlich
Institute of Biostatistics and Clinical Research, University Muenster, Germany
Wolfgang E. Berdel
Department of Medicine A, Hematology and Oncology, University Hospital of Muenster, Germany;Cluster of Excellence EXC 1003, Cells in Motion, Germany
Patients undergoing intensive chemotherapy for acute myeloid leukemia are at high risk for bacterial infections during therapy-related neutropenia. However, the use of specific antibiotic regimens for prophylaxis in afebrile neutropenic acute myeloid leukemia patients is controversial. We report a retrospective evaluation of 172 acute myeloid leukemia patients who received 322 courses of myelosuppressive chemotherapy and had an expected duration of neutropenia of more than seven days. The patients were allocated to antibiotic prophylaxis groups and treated with colistin or ciprofloxacin through 2 different hematologic services at our hospital, as available. The infection rate was reduced from 88.6% to 74.2% through antibiotic prophylaxis (vs. without prophylaxis; P=0.04). A comparison of both antibiotic drugs revealed a trend towards fewer infections associated with ciprofloxacin prophylaxis (69.2% vs. 79.5% in the colistin group; P=0.07), as determined by univariate analysis. This result was confirmed through multivariate analysis (OR: 0.475, 95%CI: 0.236–0.958; P=0.041). The prophylactic agents did not differ with regard to the microbiological findings (P=0.6, not significant). Of note, the use of ciprofloxacin was significantly associated with an increased rate of infections with pathogens that are resistant to the antibiotic used for prophylaxis (79.5% vs. 9.5% in the colistin group; P
