2377. Prophylactic Antibiotic Therapy and Blood Stream Infections in Leukemia Patients Presenting to the Emergency Center
Session: Poster Abstract Session: Transplantation - Bacterial Infections
Saturday, October 7, 2017
Room: Poster Hall CD
Background:

Patients undergoing chemotherapy for leukemia are at high risk for infection and routinely receive antibiotic prophylaxis. The types of breakthrough bloodstream infection (BSI) based on choice of prophylaxis is not well-characterized. Here, we describe antibiotic prophylaxis patterns and the influence of antibiotic choice on BSI epidemiology in leukemia patients presenting to the emergency center (EC) with neutropenic fever (NF).

Methods:

This was a retrospective chart review of patients with leukemia and NF (absolute neutrophil count [ANC] <500 cells/mm3; temperature ≥38.3°C) who presented to the EC at MD Anderson Cancer Center from January 2014 to January 2015. Patients receiving levofloxacin (LEV), ciprofloxacin (CIP), amoxicillin-clavulanate (ACL), or cefpodoxime (CEF) were included. We assessed current antibiotic prophylaxis at presentation to the EC, and correlated with microbiologically proven bloodstream infections (BSI) within the first 48 hours following presentation.

Results:

A total of 284 patients (mean age 56 ± 17 years; 63% male) were assessed. 84% of patients had neutropenia >7 days in duration and the median ANC at presentation was 0 cells/mm3 (range: 0 - 490 cells/mm3). Most patients received LEV (42%) followed by CIP (27%), CEF (25%), and ACL (6%). Forty-seven of 284 patients presented with Gram negative BSI (16%) and 36 (13%) had Gram positive BSI. Rates of common organisms causing BSI are presented in Table 1.

Conclusion:

In leukemia patients with NF presenting to the EC, rates of BSI differed significantly based on antibiotic prophylaxis choice, with P. aeruginosa BSI more common in patients receiving ACL and E. coli in patients receiving LEV. The epidemiology of breakthrough infections on different prophylactic agents may help guide empiric antibiotic choice.

Table 1. Causative organisms of BSI.

BSI Type

LEV

(n=118)

CIP

(n = 77)

CEF

(n = 72)

ACL

(n = 17)

p-value

Any Gram negative

( n = 47)

21 (18)

7 (9)

13 (18)

6 (35)

0.05

E. coli

(n = 25)

18 (15)

3 (4)

3 (4)

1 (6)

0.02

P. aeruginosa

(n = 13)

2 (2)

1 (1)

6 (8)

4 (24)

<0.01

Any Gram positive

(n = 36)

18 (16)

10 (13)

7 (10)

0

0.26

Alpha-hemolytic Streptococcus

(n=11)

4 (4)

4 (5)

2 (3)

0

0.90

Enterococcus spp.

(n=5)

0 (0)

2 (3)

3 (4)

0

0.12

All values presented as n (%)

Deeksha Jandhyala, M.D.1,2, Victor Mulanovich, MD3, Samuel L. Aitken, PharmD4, Frank P. Tverdek, PharmD4, Kayleigh R. Marx, PharmD4, Roy F. Chemaly, MD, MPH, FIDSA, FACP5, Kenneth V. I. Rolston, MD2 and Samuel A. Shelburne, MD, PhD2, (1)Division of Infectious Diseases, University of Texas Health Science Center at Houston, Houston, TX, (2)Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, (3)The University of Texas MD Anderson Cancer Center, Houston, TX, (4)Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, TX, (5)University of Texas M.D. Anderson Cancer Center, Houston, TX

Disclosures:

D. Jandhyala, None

V. Mulanovich, None

S. L. Aitken, None

F. P. Tverdek, None

K. R. Marx, None

R. F. Chemaly, Merck & Co., Inc.: Consultant and Investigator , Consulting fee , Research grant and Speaker honorarium

K. V. I. Rolston, None

S. A. Shelburne, None

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