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Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: Two parallel patient cohorts treated in a single center
Michele Pohlen, Julia Marx, Alexander Mellmann, Karsten Becker, Rolf M. Mesters, Jan-Henrik Mikesch, Christoph Schliemann, Georg Lenz, Carsten Müller-Tidow, Thomas Büchner, Utz Krug, Matthias Stelljes, Helge Karch, Georg Peters, Ulrich Gerth, Dennis Görlich, Wolfgang E. Berdel
Haematologica July 2016 : haematol.2016.147934; doi:10.3324/haematol.2016.147934
Michele Pohlen
University Hospital Muenster;
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Julia Marx
University Hospital Muenster;
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Alexander Mellmann
University Hospital Muenster;
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Karsten Becker
University Hospital Muenster;
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Rolf M. Mesters
University Hospital Muenster;
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Jan-Henrik Mikesch
University Hospital Muenster;
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Christoph Schliemann
University Hospital Muenster;
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Georg Lenz
University Hospital Muenster;
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Carsten Müller-Tidow
University Hospital Halle;
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Thomas Büchner
University Hospital Muenster;
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Utz Krug
Klinikum Leverkusen;
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Matthias Stelljes
University Hospital Muenster;
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Helge Karch
University Hospital Muenster;
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Georg Peters
University Hospital Muenster;
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Ulrich Gerth
University Hospital Muenster;
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Dennis Görlich
University Muenster
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Wolfgang E. Berdel
University Hospital Muenster;
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Author Affiliations

  1. Michele Pohlen1,*,
  2. Julia Marx1,
  3. Alexander Mellmann1,
  4. Karsten Becker1,
  5. Rolf M. Mesters1,
  6. Jan-Henrik Mikesch1,
  7. Christoph Schliemann1,
  8. Georg Lenz1,
  9. Carsten Müller-Tidow2,
  10. Thomas Büchner1,
  11. Utz Krug3,
  12. Matthias Stelljes1,
  13. Helge Karch1,
  14. Georg Peters1,
  15. Ulrich Gerth1,
  16. Dennis Görlich4 and
  17. Wolfgang E. Berdel1
  1. 1 University Hospital Muenster;
  2. 2 University Hospital Halle;
  3. 3 Klinikum Leverkusen;
  4. 4 University Muenster
  1. ↵* Corresponding author; email: michele.pohlen{at}ukmuenster.de
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Abstract

Patients undergoing intensive chemotherapy for acute myeloid leukemia are at high risk for bacterial infections during therapy-related neutropenia. However, the use of specific antibiotic regimens for prophylaxis in afebrile neutropenic acute myeloid leukemia patients is controversial. This was a retrospective evaluation of 172 acute myeloid leukemia patients who received 322 courses of myelosuppressive chemotherapy and had an expected duration of neutropenia of >7 days. The patients were allocated to antibiotic prophylaxis groups and treated with colistin or ciprofloxacin through 2 different hematological services at our hospital as available. The infection rate was reduced from 88.6% to 74.2% through antibiotic prophylaxis (vs. without prophylaxis, p=0.04). A comparison of both antibiotic drugs revealed a trend towards fewer infections associated with ciprofloxacin prophylaxis (69.2% vs. 79.5% in the colistin group, p=0.07), as determined by univariate analysis. This result was confirmed through multivariate analysis (OR 0.475, 95%CI 0.236-0.958; p=0.041). The prophylactic agents did not differ with regard to the microbiological findings (p=0.6, n.s.). Of note, the use of ciprofloxacin was significantly associated with an increased rate of infections with pathogens that are resistant to the antibiotic used for prophylaxis (79.5% vs. 9.5% in the colistin group, p<0.0001). The risk factors for higher infection rates were the presence of a central venous catheter (p<0.0001), mucositis grade III/IV (p=0.0039), and induction/relapse courses (vs. consolidation, p<0.0001). Concluding, ciprofloxacin prophylaxis appears to be of particular benefit during induction and relapse chemotherapy for acute myeloid leukemia. To prevent and control drug resistance, it may be safely replaced by colistin during consolidation cycles of acute myeloid leukemia therapy.

  • Received April 22, 2016.
  • Accepted July 19, 2016.
  • Copyright © 2016, Ferrata Storti Foundation
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Keywords

acute myeloid leukemia
Infectious Disorders
antibiotic prophylaxis
neutropenia

Vol 104 Issue 2

Haematologica: 104 (2)
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Ciprofloxacin versus colistin prophylaxis during neutropenia in acute myeloid leukemia: Two parallel patient cohorts treated in a single center
Michele Pohlen, Julia Marx, Alexander Mellmann, Karsten Becker, Rolf M. Mesters, Jan-Henrik Mikesch, Christoph Schliemann, Georg Lenz, Carsten Müller-Tidow, Thomas Büchner, Utz Krug, Matthias Stelljes, Helge Karch, Georg Peters, Ulrich Gerth, Dennis Görlich, Wolfgang E. Berdel
Haematologica Jul 2016, haematol.2016.147934; DOI: 10.3324/haematol.2016.147934

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Michele Pohlen, Julia Marx, Alexander Mellmann, Karsten Becker, Rolf M. Mesters, Jan-Henrik Mikesch, Christoph Schliemann, Georg Lenz, Carsten Müller-Tidow, Thomas Büchner, Utz Krug, Matthias Stelljes, Helge Karch, Georg Peters, Ulrich Gerth, Dennis Görlich, Wolfgang E. Berdel
Haematologica Jul 2016, haematol.2016.147934; DOI: 10.3324/haematol.2016.147934
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