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Introduction <p>Hematopoietic cell transplantation (HCT) carries a high infection risk, especially pre-engraftment. Fluoroquinolone (FQ) prophylaxis is common, but rising FQ-resistant Enterobacterales (FQRE) rates may limit its effectiveness. This study evaluated febrile neutropenia, bacteremia, and mortality in HCT patients based on FQ prophylaxis and FQRE colonization.</p> Methods <p>A retrospective analysis of HCT recipients at a tertiary center in Lebanon (2017–2022) was performed. Patients receiving FQ prophylaxis during neutropenia were compared with those who did not. FQRE colonization was monitored through weekly perianal swabs post-transplant.</p> Results <p>Of 156 HCT recipients (mean age 54 years; 61% males), 73.1% received FQ prophylaxis, and 39% had FQRE colonization. Febrile neutropenia occurred in 86%, more frequently in non-prophylaxis and FQRE-colonized patients, though prophylaxis delayed its onset within 10 days post-transplant. Bacteremia affected 39.1% of 64 eligible patients, with lower rates in the prophylaxis group (35.7% vs. 62.5%, <i>p</i> = 0.02). <i>Escherichia coli</i> and coagulase-negative staphylococci predominated. All-cause mortality was 3.8%, with pneumonia and <i>Clostridioides difficile</i> infections in 5.1% and 3.2%, respectively; prophylaxis showed non-significant reductions in these outcomes.</p> Conclusion <p>FQ prophylaxis reduced febrile neutropenia and bacteremia in HCT recipients, including those colonized with FQRE. Larger studies are needed to confirm its effects on multiple outcomes.</p> Clinical trial number <p>Not applicable.</p>

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The impact of fluoroquinolone-resistant enterobacterales colonization on fluoroquinolone prophylaxis efficacy in hematopoietic cell transplant recipients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月14日

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  • Rima Moghnieh,
  • Ahmad Khalil,
  • Antoine Khoury,
  • Hilal Abdessamad,
  • Pamela Sfeir,
  • Mariana Mezher,
  • Monica Abi Abdallah,
  • Bilal Hamade,
  • Kamal Zahran,
  • Edmond Abboud,
  • Aysar Fakih,
  • Rana Attieh,
  • Farah Hneini,
  • Marilyne Sily,
  • Wael Zorkot,
  • Shadi Eid,
  • Dania Abdallah,
  • Ahmad Ibrahim

摘要

Introduction

Hematopoietic cell transplantation (HCT) carries a high infection risk, especially pre-engraftment. Fluoroquinolone (FQ) prophylaxis is common, but rising FQ-resistant Enterobacterales (FQRE) rates may limit its effectiveness. This study evaluated febrile neutropenia, bacteremia, and mortality in HCT patients based on FQ prophylaxis and FQRE colonization.

Methods

A retrospective analysis of HCT recipients at a tertiary center in Lebanon (2017–2022) was performed. Patients receiving FQ prophylaxis during neutropenia were compared with those who did not. FQRE colonization was monitored through weekly perianal swabs post-transplant.

Results

Of 156 HCT recipients (mean age 54 years; 61% males), 73.1% received FQ prophylaxis, and 39% had FQRE colonization. Febrile neutropenia occurred in 86%, more frequently in non-prophylaxis and FQRE-colonized patients, though prophylaxis delayed its onset within 10 days post-transplant. Bacteremia affected 39.1% of 64 eligible patients, with lower rates in the prophylaxis group (35.7% vs. 62.5%, p = 0.02). Escherichia coli and coagulase-negative staphylococci predominated. All-cause mortality was 3.8%, with pneumonia and Clostridioides difficile infections in 5.1% and 3.2%, respectively; prophylaxis showed non-significant reductions in these outcomes.

Conclusion

FQ prophylaxis reduced febrile neutropenia and bacteremia in HCT recipients, including those colonized with FQRE. Larger studies are needed to confirm its effects on multiple outcomes.

Clinical trial number

Not applicable.