RESUMEN
Objectives: Fluroquinolone prophylaxis during haematopoietic cell transplantation (HCT) remains contentious. We aimed to determine its effectiveness and association with exposure to treatment antimicrobials and antimicrobial resistance. Methods: All admission episodes for HCT (Nâ=â400â, 372 unique patients) in a tertiary centre between January 2020 and December 2022 were studied. Allogeneic HCT (allo-HCT) recipients received prophylaxis with ciprofloxacin during chemotherapy-induced neutropenia, while autologous HCT (auto-HCT) recipients did not. Results: Allo-HCT was performed for 43.3% (173/400) of patients, auto-HCT for 56.7% (227/400). Allo-HCT was associated with an average of 1.01 fewer infection episodes per 100 admission days (95% CI 0.62-1.40, Pâ<â0.001) compared with auto-HCT. In allo-HCT, the total exposure to all antimicrobials was higher [+24.8 days of therapy (DOT)/100 admission days, Pâ<â0.001], as was exposure to ciprofloxacin (+40.5 DOT/100 admission days, Pâ<â0.001). By contrast, exposure to meropenem (-4.5 DOT/100 admission days, Pâ=â0.02), piperacillin/tazobactam (-5.2 DOT/100 admission days, Pâ<â0.001), aminoglycosides (-4.5 DOT/100 admission days, Pâ<â0.001) and glycopeptides (-6.4 DOT/100 admission days, Pâ<â0.001) was reduced. Enterobacteriaceae isolated during allo-HCT were more resistant to ciprofloxacin (65.5%, 19/29 versus 6.1%, 2/33, Pâ<â0001), ceftriaxone (65.5%, 19/29 versus 9.1%, 3/33, Pâ<â0.001), other antimicrobial classes. Vancomycin-resistant enterococci were more common in allo-HCT recipients (11%, 19/173 versus 0.9%, 2/227, Pâ<â0.001). Inpatient mortality during allo- and auto-HCT was 9.8% (17/173) and 0.4% (1/227). respectively (Pâ<â0.001). Conclusions: Ciprofloxacin prophylaxis in allo-HCT was associated with fewer infection episodes and reduced exposure to treatment antimicrobials. Mortality in auto-HCT remained low. A significant burden of antimicrobial resistance was detected in allo-HCT recipients.