Hematopoietic Stem Cell Transplant Recipients Colonized with Fluoroquinolone-Resistant Enterobacteriaceae at High Risk for Bacteremia

Although fluoroquinolone prophylaxis is recommended during the period of neutropenia for most patients undergoing hematopoietic stem cell transplant (HSCT), increased rates of fluoroquinolone-resistant Enterobacteriaceae may limit the effectiveness of this intervention (NEJM JW Infect Dis Jan 2019 and J Clin Oncology 36:3043). Now, investigators have assessed outcomes in 312 HSCT recipients who received levofloxacin prophylaxis beginning 1 day before transplant.

Perianal swabs were obtained at admission and then weekly. Thirty-one patients (10%) were colonized with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) at baseline; 25% of these organisms were sensitive to levofloxacin. Ten patients with baseline ESBL-E colonizat…