Hematolojik Kanserli Hastalarda Kinolon Profilaksisinin Morbidite, Mortalite ve Fekal Kinolon Dirençli E. Colı Kolonizasyonuna Etkisi

Abstract

Quinolone prophylaxis has been widely used in order to reduce the incidence of gram-negative bacteremia and related mortality in high risk hematological cancer patients. However, quinolone resistance in gram-negative bacteria has been increasing globally. In this study, the effects of levofloxacin prophylaxis on colonization rates with gram-negative bacteria, the rate of gram-negative bacteremia, and related mortality in high-risk hematologic cancer patients were investigated. The study was completed in two parts. In the first part, the presence and emergence of quinolone-resistant E. coli (E. coli QR) was investigated before and after the initiation of levofloxacin prophylaxis in 142 high-risk (207 episodes) hematologic cancer patients by perirectal swabs. In the second part, the effects of levofloxacin prophylaxis on morbidity, mortality and on rates of offending bacteria causing infection were investigated. For this purpose, between January 2006 and April 2013, 80 acute leukemia patients (249 neutropenic episodes) receiving levofloxacin prophylaxis were compared to 103 acute leukemia patients (355 neutropenic episodes) without prophylaxis. In the first part; before quinolone prophylaxis, in 60 of 142 patients (42.2%), QR E. coli was isolated by perirectal swabs. After the first sample, 11 patients could not be followed-up for several reasons. Among the remaining 71 patients, 33 of (46.4%) were found colonized with QR E. coli after levofloxacin prophylaxis during follow-up. In the second part of the trial, in patients receiving levofloxacin prophylaxis, microbiological and clinical incidence of documented infections, number of febrile neutropenic episodes, number of days of febrile neutropenia, frequency of gram-positive and gram-negative bacteremic neutropenic episodes were significantly low (p <0.05 as compared to the patients without prophylaxis. The frequency of quinolone resistance in patients with gram-negative bacteremia with or without prophylaxis were 72%and52.3%, , respectively. In conclusion, this study shows that, although quinolone prophylaxis increases the rate of colonization with QR E. coli in high-risk hematologic cancer patients, and the incidence of quinolone resistance in gram-negative bacteria casuing bacteremia, it significantly decreases the incidence of bacteremia, and related morbidity and mortality.