Prophylaxis with levofloxacin: impact on bacterial susceptibility and epidemiology in a hematopoietic stem cell transplant unit
Rev. bras. hematol. hemoter
;
36(1): 35-42, Jan-Feb/2014. tab, graf
Article
in English
| LILACS
| ID: lil-703699
ABSTRACT
Background:
The emergence of resistance has been demonstrated in cancer treatment centers where prophylaxis with fluoroquinolone is used.Objective:
Considering the importance of epidemiological monitoring as a strategy in choosing protocols involving antibiotics, this study aimed to evaluate the emergence of quinolone resistance and changes in the local epidemiology in a hematopoietic stem cell transplant service.Methods:
For this study, 60 positive cultures before the prophylactic use of levofloxacin (period A 2007-2008) and 118 cultures after starting the use of prophylactic levofloxacin (period B 2010-2011) were evaluated.Results:
Resistance increased for all the different types of bacteria isolated (from 46.0% to 76.5%; p-value = 0.0002). Among Gram-negative bacteria, resistance increased from 21.4% to 60.7% (p-value = 0.0163) and among Gram-positive bacteria, it increased from 55.6% to 82.9% (p-value = 0.0025). The use of levofloxacin increased from 19.44 defined daily doses per 1,000 patient-days in period A to 166.64 in period B. The use of broad spectrum antibiotics remained unchanged. Considering bacteria associated with infection, 72 and 76 were isolated in periods A and B, respectively. There was a reduction in the rate of Gramnegative bacteria in cultures associated with infection (3.81 vs. 2.00 cultures/1,000 patientdays; p-value = 0.008).Conclusion:
The study of prophylaxis with levofloxacin demonstrated that there was a decrease in infections by Gram-negative bacteria; however, bacterial resistance increased, even though the use of broad-spectrum antibiotics remained unchanged. Constant monitoring of local epidemiology combined with research on clinical outcomes is needed to evaluate the effectiveness of prophylaxis. .
Full text:
Available
Index:
LILACS (Americas)
Main subject:
Drug Resistance
/
Ofloxacin
/
Epidemiology
/
Hematopoietic Stem Cell Transplantation
/
Antibiotic Prophylaxis
/
Fluoroquinolones
/
Disease Susceptibility
Type of study:
Practice guideline
/
Screening study
Limits:
Adolescent
/
Humans
Language:
English
Journal:
Rev. bras. hematol. hemoter
Journal subject:
Hematology
Year:
2014
Type:
Article
Affiliation country:
Brazil
Institution/Affiliation country:
Universidade Federal do Paraná/BR
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