Comparison of Ciprofloxacin versus Levofloxacin and Rate of Breakthrough Infection in Hematopoietic Stem Cell Transplant Patients

Background: Infection is a serious complication of hematopoietic stem cell transplantation and guidelines recommend fluoroquinolone prophylaxis. Ciprofloxacin was recently replaced by levofloxacin as the preferred agent on the Northwestern Memorial Hospital (NMH) formulary. The study objective is to compare differences in rate of breakthrough infections for ciprofloxacin versus levofloxacin prophylaxis in an autologous stem cell transplant population.

Methods: This is a retrospective, cohort study comparing consecutive patients that received ciprofloxacin (1/2007-5/2008) prophylaxis vs. levofloxacin (1-12/2015) prophylaxis for adult autologous HSCT with multiple myeloma who received high-dose melphalan. Endpoints include: differences in rectal colonization with VRE, time to engraftment, length of treatment, Clostridium difficile infection,rate of febrile neutropenia, incidence of breakthrough infections, and inpatient mortality. This study was IRB approved by Northwestern University.

Results: 164 ciprofloxacin and 155 levofloxacin patients were included. There was no difference in baseline characteristics, length of treatment, Clostridium difficile infection, or febrile neutropenia between the study groups. There was a significantly higher incidence of bloodstream infections in the ciprofloxacin group (24/154) compared to levofloxacin group (10/143) p=0.03, primarily caused by a statistically higher incidence of gram positive bloodstream infections (ciprofloxacin (21/154) versus levofloxacin (8/143); p<0.01). Significantly higher rates of VRE rectal colonization were seen in ciprofloxacin-treated patients (p<0.01). There was no difference in inpatient mortality.

Conclusion: Ciprofloxacin prophylaxis was associated with a significantly higher rate of breakthrough bloodstream infections during HSCT compared to levofloxacin, with no difference in inpatient mortality.