416. Comparison of Levofloxacin (L) versus Levofloxacin plus Doxycyline (L-D) for Febrile Neutropenia (FN) Antibiotic (Abx) Prophylaxis (Px) in Patients Undergoing Autologous Hematopoietic Stem Cell Transplants (aHSCT)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The reduction of incidence of FN and documented bloodstream isolates (BSI), many caused by gram-positive (Gm+) bacteria, facilitates the outpatient (OP) management of patients (pts) receiving aHSCT. In order to improve Gm+ coverage, D 100 mg PO BID was added to our standard L 500mg PO Q24H Px - both starting on Day -2 of aHSCT. We reviewed the impact of this change in Px regimen on outcomes in our aHSCT pts.
Methods: Retrospective chart review was conducted of 143 pts who received either L Px (112 pts) or L-D Px (31 pts) during aHSCT with either high-dose melphalan (MEL) [61 pts] or carmustine/etoposide/cytarabine/melphalan (BEAM) [82 pts] conditioning regimen from Sept ‘07 to Aug ‘08 .
Results: In our L group, 17 % of patients did not require empiric FN antibiotic intervention (AbxI) compared to 32 % of the pts in the L-D group (p= 0.04). The mean (m) day for the start of FN was 5.6 days after aHSCT (5.4 vs 6.2). The m length of days for FN AbxI was 7.1 days (7.4 vs 6.8). The m ANC at the start of FN was 325 (371 vs 102). Cultures were positive in 32 pts with 39 isolates (5 gram negative (Gm-) isolates, 34 Gm+ isolates). Coagulase negative staphylococci was isolated in 20 pts (18 in L group, 2 in L-D group) where 6/20 were sensitive (S) to quinolones (Q) and 11/20 S to tetracycline (TCN). Streptococcus viridans was found in 6 isolates (4 in the L group and 2 in L-D group) all found resistant to Q (not tested against TCN) . MRSA was seen in 2 isolates in the L group (both S to TCN).
Conclusion: The addition of D to L in aHSCT Abx Px significantly reduced the incidence of FN in this retrospective study. L-D Px in aHSCT may allow for more pts to receive aHSCT conditioning chemotherapy regimens in the OP setting, potentially reducing hospital admissions and cost thus warranting further studies.
Robert Bradbury, R Ph, MA1, Donn Davis, PharmD1, Hugo Fernandez, MD1, John Greene, MD1, Rod Quilitz, PharmD, BCOP and  D. Davis, None..
R. Bradbury, None..
H. Fernandez, None..
J. Greene, None..
R. Quilitz, None., (1)H. Lee Moffitt Cancer Center, Tampa, FL