Abstract：
Introduction. Fluoroquinolone prophylaxis during haematopoietic cell transplantation (HCT) can lead to antimicrobial resistance (AMR). Identifying the groups of patients that have the highest likelihood of benefiting from prophylactic antimicrobials is important for antimicrobial stewardship (AMS).Hypothesis. We aimed to identify groups of HCT recipients that have the highest likelihood of benefiting from prophylactic fluroquinolones.Methods. All admissions for HCT in a tertiary centre between January 2020 and December 2022 (N = 400) were retrospectively studied. Allogeneic HCT (allo-HCT) recipients had prophylaxis with ciprofloxacin during the chemotherapy-induced neutropenia, while autologous HCT (auto-HCT) recipients did not. Bacteraemias were recorded when non-contaminant bacterial pathogens were isolated in blood cultures.Results. Allo-HCT was performed for 43.3 % (173/400) of patients and auto-HCT was performed for 56.7 % (227/400). A bacteraemia was documented in 28.3 % (113/400) of cases. Allo-HCT recipients were more likely to have a Gram-positive bacteraemia (20.8%, 36/173, vs 10.1%, 23/227, P = 0.03), while a difference was not observed for Gram-negative bacteraemias (18.5%, 32/173 vs 18.1%, 41/227, P = 0.91). Among auto-HCT recipients not receiving ciprofloxacin prophylaxis, patients with germ cell tumours had the highest probability (P for trend 0.09) of recording any bacteraemia (43.5%, 10/23) followed by patients with lymphomas (32.5%, 13/40), other auto-HCT indications (22.2%, 2/9), multiple myeloma (22.1%, 29/131) and multiple sclerosis (12.5%, 3/24). The higher number of bacteraemias in patients with germ cell tumours was primarily driven by Gram-negative pathogens.Conclusions. Ciprofloxacin prophylaxis was associated with a reduced incidence of Gram-negative bacteraemias in allo-HCT recipients. Auto-HCT recipients due to germ cell tumours, not receiving ciprofloxacin prophylaxis, recorded the highest incidence of bacteraemias and represent a possible target group for this intervention.
摘要：
Introduction.在造血细胞移植（HCT）期间预防氟喹诺酮可导致抗菌素耐药性（AMR）。确定最有可能受益于预防性抗菌药物的患者群体对于抗菌药物管理（AMS）很重要。假说。我们旨在确定从预防性氟喹诺酮类药物获益的可能性最高的HCT受者群体。方法。回顾性研究了2020年1月至2022年12月在三级中心接受HCT的所有入院（N=400）。同种异体HCT（allo-HCT）接受者在化疗诱导的中性粒细胞减少症中使用环丙沙星进行预防，而自体HCT（auto-HCT）接受者则没有。当在血液培养物中分离出无公害细菌病原体时，就记录了细菌。结果。对43.3%(173/400)的患者进行了allo-HCT，对56.7%(227/400)的患者进行了auto-HCT。在28.3％（113/400）的病例中记录了菌血症。Allo-HCT受者更有可能患有革兰氏阳性菌血症（20.8%，36/173，对10.1%，23/227，P=0.03），而革兰氏阴性菌血症没有观察到差异(18.5%，32/173vs18.1%，41/227,P=0.91)。在未接受环丙沙星预防的自体HCT接受者中，生殖细胞肿瘤患者记录任何菌血症的概率最高（P为趋势0.09）（43.5％，10/23）其次是淋巴瘤患者（32.5%，13/40），其他自动HCT适应症（22.2%，2/9),多发性骨髓瘤（22.1%，29/131）和多发性硬化症（12.5%，3/24）。生殖细胞肿瘤患者的细菌增多主要是由革兰氏阴性病原体引起的。Conclusions.在allo-HCT受者中，环丙沙星的预防与革兰氏阴性细菌的发生率降低有关。由于生殖细胞肿瘤，自动HCT接受者，不接受环丙沙星预防，记录了细菌血症的最高发生率，并代表了该干预措施的可能目标人群。
