Antimicrobial prophylaxis in neutropenic patients undergoing peripheral blood stemcell or bone marrow transplantation

Abstract number: R2515

Dettenkofer M., Babikir R., Wenzler-Röttele S., Bertz H., Kern W., Widmer A., Meyer E.

Objectives: To assess antimicrobial prophylaxis in neutropenic patients undergoing bone marrow transplantation (BMT) or peripheral blood-stem cell transplantation (PBSCT) and analyse the data in relation with the incidence of nosocomial infections. Data were taken from ONKO-KISS (Hospital Infection Surveillance System for Patients with Hematologic/Oncologic Malignancies), an ongoing multicentre surveillance project established by the German National Reference Centre for Surveillance of Nosocomial Infections in 2000 [CID 2005; 40: 926].

Methods: Nosocomial Infections were identified using CDC definitions for laboratory-confirmed blood stream infection (BSI) and modified criteria for pneumonia in neutropenic patients [for detailed information and reference data see http://www.nrz-hygiene.de/surveillance/onko.htm]. Information on antimicrobial prophylaxis was obtained by a questionnaire sent to all ONKO-KISS participants.

Results: 10 out of 14 centres treating patients with allogeneic BMT or PBSCT returned the questionnaire. All routinely administered systemic antibiotics (9/10 cotrimoxazole, 6/10 ciprofloxacin, 4/10 levofloxacin and 2/10 other antibiotics), as well as antiviral agents. Systemic antifungal prophylaxis was applied by 9 of the 10 centres.

14 out of 19 centres treating patients with autologous BMT or PBSCT returned the questionnaire. 3 out of 14 did not routinely give systemic antibiotic prophylaxis. Only 5 centres applied systemic antifungals and half (7/14) applied antiviral agents. 3 participants had only recently joined the ONKO-KISS system and thus reported few or no data on nosocomial infections. 9 of the remaining 11 centres available for analysis administered systemic antibiotics. The incidence of BSI/1000 neutropenic days was 15.7 and of pneumonia 5.8 in this group (data from 7/2002–6/2007). In contrast, the 2 centres that did not give any antibiotic prophylaxis reported 19.4 cases of BSI and 8.1 cases of pneumonia per 1000 neutropenic days.

Conclusions: Our results offer very preliminary data suggesting that antibiotic prophylaxis is of benefit to these high risk patients in the prevention of nosocomial infections. However, the influence on the development of antimicrobial resistance must be closely monitored. It might be reasonable to consider routine administration of antibiotics also in autologous BMT/PBSCT in the case of above-average infection rates.