Impact of Levofloxacin Prophylaxis on Rates of Bloodstream Infection and Fever and Neutropenia in Autologous Stem Cell Transplant Recipients with Lymphoma

Background: Few contemporary studies have evaluated the role of antibacterial prophylaxis during neutropenia in patients with lymphoma undergoing autologous hematopoietic stem cell transplantation (HSCT).

Methods: At our center, levofloxacin prophylaxis was initiated during neutropenia in February 2012 in autologous HSCT recipients with lymphoma. We compared the incidence of bloodstream infection (BSI) and fever and neutropenia (FN) within 30 days of transplantation before (February 2008-January 2012) and after (February 2012-October 2015) the initiation of levofloxacin prophylaxis. A multivariable logistic regression model was constructed to determine whether levofloxacin prophylaxis was independently associated with these outcomes. Finally, we compared rates of BSI due to multidrug-resistant (MDR) bacteria (e.g., methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, levofloxacin-resistant or ceftriaxone-resistant Enterobacteriaceae) and the rate of Clostridium difficile infection within 90 days of transplantation before and after this intervention.

Results: After initiation of levofloxacin prophylaxis, the rate of BSI decreased from 39% (41/104) to 18% (18/87; P = 0.002). This decline was largely due to decreases in the rates of Gram-negative bacteremia (28% vs. 5%, P < 0.001) and bacteremia caused by Enterobacteriaceae (22% vs. 3%, P < 0.001). There was a non-significant decrease in the rate of Gram-positive bacteremia from 21% to 14% (P = 0.19). Levofloxacin prophylaxis was independently associated with decreased odds of BSI (odds ratio 0.38; 95% confidence interval, 0.18-0.79; P = 0.009) in multivariable analysis. There was no change in the rate of BSI due to MDR bacteria (11% vs. 8%), C. difficile infection (6% vs. 7%), or 30-day mortality (5% vs. 1%) between study periods. On the other hand, there was only a non-significant trend towards a decreased rate of febrile neutropenia before and after the initiation of levofloxacin prophylaxis (90% vs. 83%; P = 0.12).

Conclusion: Levofloxacin prophylaxis is associated with a decreased risk of BSI in patients with lymphoma undergoing autologous HSCT, without a concurrent increased risk of BSI caused by MDR bacteria or C. difficile infection.