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      Prophylactic Antibiotic Therapy and Blood Stream Infections in Leukemia Patients Presenting to the Emergency Center

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          Abstract

          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/mm 3; 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. Eighty-four% of patients had neutropenia >7 days in duration and the median ANC at presentation was 0 cells/mm 3 (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 (%).

          Disclosures

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

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          Author and article information

          Journal
          Open Forum Infect Dis
          Open Forum Infect Dis
          ofid
          Open Forum Infectious Diseases
          Oxford University Press (US )
          2328-8957
          Fall 2017
          04 October 2017
          04 October 2017
          : 4
          : Suppl 1 , ID Week 2017 Abstracts
          : S709
          Affiliations
          [1 ] Division of Infectious Diseases, University of Texas Health Science Center at Houston , Houston, Texas
          [2 ] Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center , Houston, Texas
          [3 ] Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center , Houston, Texas
          [4 ] Division of Pharmacy, The University of Texas MD Anderson Cancer Center , Houston, Texas
          Author notes

          Session: 254. Transplantation - Bacterial Infections

          Saturday, October 7, 2017: 12:30 PM

          Article
          ofx163.1903
          10.1093/ofid/ofx163.1903
          5631468
          6eb7414d-a309-4e64-bbc2-6d11630cc4ac
          © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

          This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

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