1595. Impact of levofloxacin for the prophylaxis of bloodstream infection on the gut microbiome in patients with hematologic malignancy
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Background: Prophylactic antibiotics for the prevention of bloodstream infections (BSIs) during neutropenia (NTP) may reduce the incidence of BSIs, NTP fever, and mortality. However, antibiotics may also result in dysbiosis of the gut microbiome. We aimed to study the impact of levofloxacin prophylaxis compared to broad-spectrum beta-lactam (BSBL) antibiotics used for the treatment of NTP fever on gut microbiome features in patients with hematologic malignancy.

Methods: Stool specimens from hematologic malignancy patients admitted for chemotherapy or stem cell transplant (SCT) in the setting of the evaluation of diarrhea were collected from 9/2017 to 11/2017. Levofloxacin prophylaxis was standard of care for patients undergoing autologous SCT or induction chemotherapy for acute myeloid leukemia (AML). 16S rRNA (V1-V2 amplicon) sequencing was performed using the Illumina HiSeq platform, formation of operational taxonomic units (OTUs) was performed using QIIME 1.9.1, and taxonomic assignment was performed via the GreenGenes database (13.8). Descriptive statistics were used to compare microbiome features.

Results: A total of 57 samples from 44 patients were included, most with AML (42%), multiple myeloma (33%), or non-Hodgkin’s lymphoma (12%). In the 7 days prior to sample collection, 28 (49%) patients received a BSBL and 17 (29%) received levofloxacin. The gut microbiome of patients with BSBL exposure had significantly reduced Shannon alpha diversity compared to those without: median 1.96 (IQR 1.08-2.57) vs 2.58 (IQR 2.05-2.93); P<0.01. However, those with and without levofloxacin exposure showed no difference: median 2.37 (IQR 2.19-2.75) vs 2.22 (IQR 1.71-2.81), respectively; P=0.48. Additionally, those with BSBL exposure trended toward increased dominance with non-Bacteroidetes taxa: 14 (60%) vs 14 (41%); P=0.14. In contrast, levofloxacin exposure was associated with a lower risk of dominance: 2 (8%) vs 15 (55%); P<0.01 and was associated with a greater proportion of Bacteroidetes taxa: 75% vs 27% (P<0.01).

Conclusion: Our findings suggest that the impact of antibiotics on the gut microbiome vary by class, and that levofloxacin may have limited impact on the gut microbiome in this patient population. Further studies are needed to investigate this potential differential impact of antibiotic classes.

Matthew Ziegler, MD1, Jennifer H. Han, MD, MSCE2, Daniel Landsburg, MD3, David Pegues, MD, FIDSA, FSHEA4, Emily Reesey, MS5, Cheryl Gilmar, MS, MT, CIC6, Theresa Gorman, MSN, RN, AOCNS3, Kristen Bink, MSN, RN, AGCNS-BC3, Amy Moore, MSN, RN, ACNS-BC3, Brendan J. Kelly, MD, MS7 and CDC Prevention Epicenters Program, (1)Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (2)Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (3)Division of Hematology and Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (4)Healthcare Epidemiology, Infection Prevention and Control, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, (5)University of Pennsylvania, Philadelphia, PA, (6)Infection Prevention and Control, Hospital of the University of Pennsylvania, Philadelphia, PA, (7)Division of Infectious Diseases, Dept. of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA


M. Ziegler, None

J. H. Han, None

D. Landsburg, None

D. Pegues, DaVita / Total Renal Care: Consultant , Consulting fee .

E. Reesey, None

C. Gilmar, None

T. Gorman, None

K. Bink, None

A. Moore, None

B. J. Kelly, None

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