2325. Risk of Bacterial Infections is Not Increased in Children Receiving Allogeneic Hematopoietic Stem Cell Transplantation Without Ciprofloxacin Prophylaxis
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Stem Cell Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • Poster final.pdf (163.4 kB)
  • 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 3rdconsecutive 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, 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

    Gabriel Vinasco-Sanchez, MD1, Oscar Ramirez-Wurttemberger, MD2, Pio Lopez, MD3, Juan Pablo Calle-Giraldo, MD1, Carlos Andres Portilla, MD2, Isabel Cristina Hurtado, MD4 and Eduardo Lopez-Medina, MD5, (1)Pediatrics, Universidad del Valle, Cali, Colombia, (2)Pediatrics, Centro Medico Imbanaco, Cali, Colombia, (3)Pediatrics, Universidad del Valle & Centro de Estudios en Infectologia Pediatrica, Cali, Colombia, (4)Pediatrics, Centro de Estudios en Infectologia Pediatrica, Cali, Colombia, (5)Pediatrics, Universidad del Valle, Centro de Estudios en Infectologia Pediatrica & Centro Medico Imbanaco, Cali, Colombia

    Disclosures:

    G. Vinasco-Sanchez, None

    O. Ramirez-Wurttemberger, None

    P. Lopez, None

    J. P. Calle-Giraldo, None

    C. A. Portilla, None

    I. C. Hurtado, None

    E. Lopez-Medina, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.