Fluoroquinolone Prophylaxis Uncovers High Prevalence Rates of Fluoroquinolone-Resistant Enterobacterales Colonization in Multiple Myeloma Autologous Transplant Patients: A Prospective Cohort Study.
Simple Summary: Fluoroquinolone prophylaxis for patients undergoing autologous stem cell transplantation (aSCT) reduces the risk of fever but raises the risk of bloodstream infection (BSI) with fluoroquinolone-resistant Enterobacterales (FRE). We performed a prospective cohort study of colonic FRE c...
| Publicado en: | Cancers Vol. 18; no. 10; pp. 1566 - 1585 |
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| Autores principales: | , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
MDPI
May2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=194129244&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 194129244 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20726694 B74B jtl: Cancers issn: 20726694 maglogo: N pubinfo: dt: May2026 vid: 18 iid: 10 pid: 97109 pub: MDPI artinfo: ui: 194129244 194129244 194129244 10.3390/cancers18101566 194129244 ppf: 1566 ppct: 19 formats: tig: atl: Fluoroquinolone Prophylaxis Uncovers High Prevalence Rates of Fluoroquinolone-Resistant Enterobacterales Colonization in Multiple Myeloma Autologous Transplant Patients: A Prospective Cohort Study. aug: au: Patel, Chintan Terlecky, Austin J. Baker, Melissa Lozy, Tara Yen, Kelly K. Kaur, Navjot Machere, Lauren Ali, Alaa Cho, Christina Donato, Michele L. Munshi, Pashna N. Kreiswirth, Barry N. Rowley, Scott D. affil: John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA sug: subj: Multiple Myeloma Therapy Hematopoietic Stem Cell Transplantation Adverse Effects Antiinfective Agents, Fluoroquinolone Pharmacodynamics Antibiotic Prophylaxis Drug Resistance, Microbial Bacterial Colonization Transplant Recipients Human Funding Source Prospective Studies Descriptive Statistics Melphalan Administration and Dosage Fisher's Exact Test Pearson's Correlation Coefficient Chi Square Test T-Tests Wilcoxon Rank Sum Test Cancer Patients beta-Lactamases Enterobacteriaceae Drug Effects Infection Control Neutropenia Immunocompromised Host ab: Simple Summary: Fluoroquinolone prophylaxis for patients undergoing autologous stem cell transplantation (aSCT) reduces the risk of fever but raises the risk of bloodstream infection (BSI) with fluoroquinolone-resistant Enterobacterales (FRE). We performed a prospective cohort study of colonic FRE colonization in a defined population of patients undergoing aSCT, exploring the detection of colonization with serial sampling before and after transplantation. FRE colonization on pre-transplant sampling was detected for 23 of 117 subjects (19.7%). Detection of FRE colonization doubled when including all three (pre- and post-transplant) sampling time points, and 48 of 117 subjects (41.0%) tested positive. Furthermore, 58 of the 90 FRE isolates (64.4%) from 48 subjects expressed extended-spectrum beta-lactamase (ESBL). We hypothesize that fluoroquinolone prophylaxis of subjects colonized with low levels of FRE allows the expansion of the FRE population, placing subjects at risk of BSI with fluoroquinolone-resistant (and ESBL-expressing) Enterobacterales. Accordingly, screening for FRE colonization permits adjustments in prophylaxis and empiric antibiotic regimens, possibly reducing serious BSI risk. Background: Fluoroquinolone prophylaxis during autologous stem cell transplantation (aSCT) reduces the risk of fever but raises the risk of bloodstream infection (BSI) with fluoroquinolone-resistant Enterobacterales (FRE). We performed a prospective cohort study to detect the presence and potential gain or loss of colonic FRE colonization using serial sampling before and after aSCT in a uniform population of patients with a diagnosis of multiple myeloma. Methods: Eligible subjects underwent aSCT after conditioning with dose-intense melphalan, 200 mg/m2. Peri-anal swabs were obtained before aSCT, upon hospital discharge, and 12–16 weeks after transplantation. Samples were cultured in tryptic soy broth supplemented with either ciprofloxacin or ceftriaxone with subsequent plating onto selective chromogenic agar designed to facilitate recovery and differentiation of Enterobacterales. Results: FRE colonization on pre-transplant sampling was detected for 23 of 117 subjects (19.7%) and 29 of 98 (29.6%) subjects at hospital discharge after a course of fluoroquinolone (116/117 subjects) prophylaxis (p < 0.001) and 28 of 92 (30.4%) subjects at 12–16 weeks. Including all three sampling time points, 48 of 117 subjects (41.0%) tested positive for FRE colonization. In total, 58 of the 90 FRE isolates (64.4%) from 48 subjects expressed extended-spectrum beta-lactamase (ESBL). Three FRE-colonized subjects developed FRE BSI. Bloodstream isolates for two subjects were identical to the organisms identified on pre-transplant sampling. Conclusions: We hypothesize that fluoroquinolone prophylaxis of subjects with undetected low levels of FRE colonization allows the expansion of the FRE population, placing subjects at risk of BSI with fluoroquinolone-resistant (and ESBL-expressing) Enterobacterales. Pre-transplant testing for FRE colonization permits patient-specific design of prophylactic and empiric antibiotic regimens. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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