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Open Access Research article

Ambulatory consolidation chemotherapy for acute myeloid leukemia with antibacterial prophylaxis is associated with frequent bacteremia and the emergence of fluoroquinolone resistant E. Coli

Lalit Saini1, Coleman Rostein2, Eshetu G Atenafu3 and Joseph M Brandwein1*

Author Affiliations

1 Department of Medical Oncology and Hematology, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Rm. 5-109, Toronto, ON M5G 2M9, Canada

2 Division of Infectious Diseases, University Health Network, Toronto, ON, Canada

3 Department of Biostatistics, Princess Margaret Hospital, University of Toronto, 610 University Avenue, Rm. 5-109, Toronto, ON M5G 2M9, Canada

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BMC Infectious Diseases 2013, 13:284  doi:10.1186/1471-2334-13-284

Published: 22 June 2013

Abstract

Background

Ambulatory consolidation chemotherapy for acute myeloid leukemia (AML) is frequently associated with bloodstream infections but the spectrum of bacterial pathogens in this setting has not been well-described.

Methods

We evaluated the emergence of bacteremias and their respective antibiotic susceptibility patterns in AML patients receiving ambulatory-based consolidation therapy. Following achievement of complete remission, 207 patients received the first cycle (C1), and 195 the second cycle (C2), of consolidation on an ambulatory basis. Antimicrobial prophylaxis consisted of ciprofloxacin, amoxicillin and fluconazole.

Results

There were significantly more positive blood cultures for E. coli in C2 as compared to C1 (10 vs. 1, p=0.0045); all E. coli strains for which susceptibility testing was performed demonstrated resistance to ciprofloxacin. In patients under age 60 there was a significantly higher rate of Streptococccus spp. bacteremia in C2 vs. C1; despite amoxicillin prophylaxis all Streptococcus isolates in C2 were sensitive to penicillin. Patients with Staphylococcus bacteremia in C1 had significantly higher rates of Staphylococcus bacteremia in C2 (p=0.009, OR=8.6).

Conclusions

For AML patients undergoing outpatient-based intensive consolidation chemotherapy with antibiotic prophylaxis, the second cycle is associated with higher rates of ciprofloxacin resistant E. coli, penicillin-sensitive Streptococcus bacteremias and recurrent Staphylococcus infections.

Keywords:
Acute myeloid leukemia; Chemotherapy; Infections; Bacteremia; Antibiotic resistance