Risk of Bacterial Infections is Not Increased in Children Receiving Allogeneic Hematopoietic Stem Cell Transplantation Without Ciprofloxacin Prophylaxis

Background:

Use of fluoroquinolone prophylaxis (FQp) is recommended in adult patients but is controversial in children receiving allogeneic hematopoietic stem cell transplantation (HSCT). We evaluated whether its use alters the risk of developing fever or bacterial infections in this population

Methods:

Retrospective chart review of children (0-18 years) receiving an HSCT for conditions other than aplastic anemia at Centro Medico Imbanaco in Cali, Colombia.

Two cohorts of patients were compared. Cohort 1 (1/1/2012 - 12/31/2015) received universal FQp from 3 days before the infusion of stem cells until engraftment. Cohort 2 (1/1/2015 - 5/1/2016) did not receive prophylaxis (No prophy). Episodes of fever and infections were documented from 3 days before stem cell infusion until the 3^rdconsecutive day of an absolute neutrophil count >500 cell/uL. Incident rates of fever and infections compared using risk ratios. Adjustment was made by time of neutropenia

Results:

Thirty seven children were included in cohort 1 and 26 in cohort 2. Overall, the mean age was 10 years (0.7-18) and 67% were male. Outcome measures according to FQp are shown in table 1

Risk of developing the outcomes of interest according to FQ exposure

Characteristics	No Prophy a	FQp (N=37)	Incidence Risk Ratio [95% CI]*	P value*
	(N=26)
Febrile episodes
# of episodes	51	49
Rate per 100
person-days	8.11	5.52	0.66 [0.44; 0.99]	0.043
Episodes of Bacterial Infections b
# of episodes	31	40
Rate per 100
person-days	4.92	4.50	1.34 [0.84; 2.16]	0.216
Microbiologic Documented Infections
# of episodes	18	22
Rate per 100
person-days	2.86	2.47	0.81 [0.43; 1.54]	0.53
MDR Gram – infection c
# of episodes	5	11
Rate per 100
person-days	0.95	1.24	1.11 [0.32; 3.83]	0.866
Gram + or susceptible gram negative infection
# of episodes	13	11
Rate per 100
person-days	2.07	1.24	0.57 [0.25; 1.31]	0.18

* Adjusted per days of neutropenia. ^a Reference group, ^b Clinically and microbiologically documented infections, ^c Multi-drug resistant, including extended spectrum betalactamases, AMP-C or carbapenem-resistant bacteria.

Conclusion:

Although FQp reduced the risk of fever, overall risk of infections or those caused by MDR was not affected. No prophy was associated with a non-statistical higher incidence of infections due to susceptible or gram + organisms. Understanding the risks and benefits of FQp will improve the use of this preventive strategy