Results
A total of 219 patients were included in the study. One hundred and
twenty-four patients had undergone autologous stem cell transplant
(ASCT) and 95 patients underwent allogeneic stem cell transplant
(AlloSCT). The first 100 patients undergoing transplant received
antibiotic prophylaxis and the next 119 patients did not receive
antibiotic prophylaxis. All patients received levofloxacin as
prophylaxis except 11 children less than 7 year of age who received
amoxicillin prophylaxis. The median age of the patients in
‘no-prophylaxis group’ was 45 years (range- 2 to 68 years) and in the
‘prophylaxis group’ it was 34.5 years (range -1 to 68 years). In both
cohorts, myeloma was the most common diagnosis of patients undergoing
ASCT. In AlloSCT group most common diagnoses were leukemia and
hemoglobinopathy. The median CD34 dose was comparable in both the
cohorts (5x 106 /kg vs 3.91 x 106/kg; p=0.111). Median neutrophil engraftment occurred at 11 days in the
no prophylaxis group and at 12 days in prophylaxis group (Table 1).
There was no difference in the median duration of hospital stay. There
was no significant difference in other baseline characteristics (Table
1).
Both groups had comparable duration of fever. However, documented
infection were significantly lower in patients who received antibiotic
prophylaxis (29% vs 42.9%; p=0.034). The patients who did not receive
antibiotic prophylaxis had higher rates of gram negative (34.5% vs
22%; p=0.043) and CRE sepsis (21% vs 1%; p=0.001) but there was no
difference in the rates of gram-positive sepsis or BSI (Table 2). We did
not observe any clostridium difficile infection.
In patients undergoing ASCT, number of febrile episodes, duration of
fever, documented infections, BSI and gram-positive BSI were not
different in prophylaxis vs no- prophylaxis group. However, GNB
infection and carbapenem resistance were significantly lower in
prophylaxis group. Despite this, overall mortality remained same in both
groups.
In patients undergoing AlloSCT, number of febrile episodes, duration of
fever, documented infections, gram-positive or gram-negative BSI was not
different in prophylaxis vs no-prophylaxis group. However, carbapenem
resistance was significantly lower in prophylaxis group (2% vs 23.9%).
This contributed to major mortality difference in AlloSCT group (vs
ASCT) in patients who did not receive antibiotic prophylaxis.
Transplant related mortality (TRM) was 8.2% for all patients. In ASCT
group 7 (5.6%) patients died while in Allo SCT group 11 (11.5%)
patients died. Antibiotic prophylaxis was not associated with reduction
in mortality (p=0.258) in both ASCT and Allo SCT groups (Table 2).