In The News: Study: Fluoroquinolones Not Linked to Resistance in Pediatric Stem Cell Transplants

Healio reports on study findings published in the Journal of the Pediatric Infectious Diseases Society regarding fluoroquinolone exposure. The researchers investigated whether fluoroquinolone prophylaxis was associated with an elevated risk for vancomycin-resistant Enterococcus (VRE) colonization. They found there did not appear to be an increased risk of developing VRE colonization following pediatric hematopoietic cell transplantation.

This was a retrospective study of 799 patients aged younger than 25 years (58.6% boys; median age, 7.3 years; interquartile range, 3.2-14 years) who had received hematopoietic cell transplantation between January 1, 203 and December 31, 2022 at Cincinnati Children’s Hospital. Citing a 2018 study of patients that suggested exposure to antimicrobials like vancomycin, fluoroquinolones and meropenem increased patients’ risk for developing VRE, the researchers screened for VRE colonization biweekly during their hospital stay.

Study researcher and PIDS member Bill Otto notes in the article that levofloxacin is used as a prophylactic antibiotic in children with leukemia or hematopoietic cell transplant recipients. He states, “There is good evidence that levofloxacin helps to prevent bloodstream infections, but there are limited data about potential adverse effects of long-term levofloxacin prophylaxis, such as antibiotic resistance.” Researchers examined levofloxacin and ciprofloxacin, noting levofloxacin was the preferred choice after 2018.

According to study findings, 55.3% of patients received levofloxacin or ciprofloxacin, and 6.9% were diagnosed with VRE colonization. For those who were exposed to fluoroquinolones, 6.3% developed VRE colonization. The low volume of patients who were colonized suggests more research is needed.

PIDS board member and JPIDS associate editor Monica Ardura provided commentary to the story. “Fluoroquinolone prophylaxis is being prescribed more frequently to high-risk children with underlying malignancy, or hematopoietic cell transplantation (HCT) recipients. With emerging immunosuppressive treatments and evolving prophylaxis strategies, it remains vital to perform surveillance and monitoring for important outcomes that assess the ongoing utility of these supportive care interventions… The benefits of antimicrobial prophylaxis (fluoroquinolones or any antimicrobial agent) in possibly preventing invasive infections in at-risk individuals must continuously be weighed against possible unintended consequences, including the potential emergence of antimicrobial resistance and untoward clinical outcomes for patients.”