KUMAR D, HUMAR A, DE AZAVEDO JC, MIYATA G, LIPTON J, BRANDWEIN J, MCGEER AJ; Interscience Conference on Antimicrobial Agents and Chemotherapy (42nd : 2002 : San Diego, Calif.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2002 Sep 27-30; 42: abstract no. C2-648.

Div. of Infectious Diseases, University Health Network, Toronto, ON, Canada.

BACKGROUND: Viridans group streptococcus (VGS) is a common cause of bacteremia in patients with hematologic malignancy. Fluoroquinolone (FQ) resistance in VGS is increasing. Fourth generation FQs may induce less resistance than older quinolones. We compared the evolution of resistance to Ciprofloxacin (Cipro) vs. Gatifloxacin (Gati) during prophylactic FQ use in patients undergoing therapy for hematologic malignancy. METHODS: 51 patients undergoing HSCT or chemotherapy for acute leukemia were randomized to prophylactic Cipro or Gati. Throat swabs were obtained at regular intervals for 8 weeks. E-test MIC to Cipro or Gati was performed on each VGS isolated. Nonsusceptibility was defined as cipro MIC of >/= 4 and gati MIC >/= 1. RESULTS: Baseline demographics, duration of neutropenia, and time on study drug were comparable in the two groups. The occurrence of fever, total febrile days, time to first fever, and AmphotericinB use were similar in the two groups (p=NS). Fewer episodes of bacteremia occurred in the Gati group (6 vs. 12 for Cipro, p=0.10). 34 patients were evaluable for resistance. Cipro resistant VGS were isolated in 16/18 (89%) patients on Cipro (mean 8.2 days to first isolate). Gati resistant VGS were isolated in 11/16 (69%) patients on Gati (mean 5.9 days to first isolate (p=0.21)). Resistance persisted for 23.4 days in Cipro vs. 34.6 days in Gati group (p=0.09). 5/18 (28%) patients in the Cipro group also developed Gati resistance;15/16 (94%) patients receiving Gati developed Cipro resistance. CONCLUSIONS: Resistance to FQ in VGS develops in the majority of patients given FQ and a class effect is seen when resistance occurs. Newer generation quinolones may have marginally lower rates of emergence of resistance.

Publication Types:

• Meeting Abstracts

Keywords:

• Bacteremia
• Ciprofloxacin
• Fever
• Fluoroquinolones
• Hematologic Neoplasms
• Humans
• Leukemia
• Microbial Sensitivity Tests
• Neutropenia
• Viridans Streptococci
• gatifloxacin

Other ID:

• GWAIDS0028550

UI: 102268174

From Meeting Abstracts