环丙沙星预防疗法对小儿急性淋巴细胞白血病早期治疗阶段血流感染的影响:观察性队列研究

Fenna Scharloo , Tom F.W. Wolfs , Tjomme van der Bruggen , Inge M. van der Sluis , Wim J.E. Tissing , Angelica M.M. de Vrankrijker
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引用次数: 0

摘要

目的 有关急性淋巴细胞白血病(ALL)患儿预防性使用抗生素疗效的数据很少,最近的指南也建议不要使用抗生素。本研究旨在评估环丙沙星预防性用药是否与降低新诊断为ALL的儿童血流感染(BSI)发病率有关。患者为 2020 年至 2021 年(预防组)或 2021 年至 2022 年(无预防组)新确诊的 ALL 患者。次要结果为儿童重症监护病房(PICU)入院率、死亡率、环丙沙星耐药性和艰难梭菌相关性腹泻(CDAD)。结果共纳入200名患者(预防组94人,无预防组106人)。环丙沙星预防可显著降低 BSI 发病率(HR 0.37;95 % CI 0.15-0.94),但与 BSI 相关的 PICU 入院率(OR 0.37;95 % CI 0.04-3.61)、BSI 相关死亡率(1.1 % vs 0 %)、全因死亡率(OR 0.55;95 % CI 0.10-3.10),以及预防组与无预防组之间的短期耐药率(16.0 % vs 13.0,OR 1.2;95 % CI,0.57-2.74)或 CDAD(0 % vs 0.9 %)。结论使用环丙沙星预防与 BSI 发生率显著降低有关。虽然这一结果显示了环丙沙星预防疗法在ALL初治阶段的有益效果,但仍需进行大样本量的RCT研究,尤其是评估其对环丙沙星耐药性的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of ciprofloxacin prophylaxis on blood stream infection during early treatment phase of pediatric acute lymphoblastic leukemia: An observational cohort study

Purpose

Data on the efficacy of antibiotic prophylaxis in children with acute lymphoblastic leukemia (ALL) is scarce and recent guidelines advise against its use. This study is conducted to evaluate if the use of ciprofloxacin prophylaxis is associated with a decrease in blood stream infection (BSI) incidence in children with newly diagnosed ALL.

Methods

This was a retrospective, observational cohort study. Patients were newly diagnosed with ALL between 2020 and 2021 (prophylaxis group) or 2021–2022 (no prophylaxis group). Primary outcome was occurrence of BSI caused by Gram-negative pathogens or Staphylococcus aureus during induction or consolidation I. Secondary outcomes were Pediatric Intensive Care Unit (PICU) admission, mortality, ciprofloxacin resistance and Clostridioides difficile-associated diarrhea (CDAD).

Results

Two hundred patients were included (prophylaxis group n=94, no prophylaxis group n=106). Ciprofloxacin prophylaxis was associated with significantly lower BSI-incidence (HR 0.37; 95 % CI 0.15–0.94) There was no significant difference for BSI-related PICU admission (OR 0.37; 95 % CI 0.04–3.61), BSI-related mortality (1.1 % vs 0 %), all-cause mortality (OR 0.55; 95 % CI 0.10–3.10), and short-term resistance rates (16.0 % vs 13.0, OR 1.2; 95 % CI, 0.57–2.74) or CDAD (0 % vs 0.9 %) between the prophylaxis group and no prophylaxis group.

Conclusion

The use of ciprofloxacin prophylaxis was associated with a significantly lower incidence of BSI. While this finding shows the beneficial effect of ciprofloxacin prophylaxis in the first treatment phase of ALL, RCTs with a large sample size are needed, particularly to assess the effect on ciprofloxacin resistance.

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