colistin and Enterocolitis--Pseudomembranous

Recent meta-analyses showed that antibiotic prophylaxis in patients with neutropenia after chemotherapy reduced the incidence of fever and mortality rate. Fluoroquinolones appear to be most effective and well tolerated. Thus, in April 2008, we changed our antibiotic prophylaxis regimen from cotrimoxazole/colistin (COT/COL) to the fluoroquinolone ciprofloxacin (CIP) in patients with acute myeloid leukemia (AML). The aim of this retrospective study was to compare efficacy and development of bacterial resistance with two different prophylaxis regimens over a time period of more than 4 years.. Induction chemotherapy courses given for AML during the antibiotic prophylaxis period with COT/COL (01/2006-04/2008) and CIP (04/2008-06/2010) were retrospectively analyzed with a standard questionnaire.. Eighty-five courses in the COT/COL group and 105 in the CIP group were analyzed. The incidence of fever was not significantly different (COT/COL 80 % vs CIP 77 %; p = 0.724). Also, the rate of microbiologically documented infections was nearly the same (29 vs 26 %; p = 0.625). In addition, there was no significant difference in the incidence of clinically documented infections (11 vs 19 %; p = 0.155) or in the rates of detected gram-positive and gram-negative bacteria. Of note, there was no increase in resistance rates or cases with Clostridium difficile-associated diarrhea in the CIP group.. The antibiotic prophylaxis with CIP compared to COT/COL in AML was similarly effective with no increase in bacterial resistance. COT/COL may have the advantages of providing additional prophylaxis against Pneumocystis jirovecii pneumonia and leaving fluoroquinolones as an additional option for treatment of febrile neutropenia.

Topics: Adult; Aged; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antineoplastic Agents; Bacterial Infections; Ciprofloxacin; Clostridioides difficile; Colistin; Diarrhea; Drug Resistance, Bacterial; Enterocolitis, Pseudomembranous; Female; Fever; Fluoroquinolones; Humans; Incidence; Leukemia, Myeloid, Acute; Male; Middle Aged; Neutropenia; Pneumocystis carinii; Pneumonia, Pneumocystis; Retrospective Studies; Surveys and Questionnaires; Trimethoprim, Sulfamethoxazole Drug Combination

The effects of orally administered gentamicin and colistin on stool bacterial flora and overall antibiotic sensitivity patterns were evaluated in 100 newborns at risk for neonatal necrotizing enterocolitis. Gentamicin (2.5 mg/kg q6h) and colistin (1 mg/kg q6h) were administered to randomly selected groups of 50 newborns for 3 wk after birth during an 11-month study period. Stools were collected on days 1, 11, and 21 and cultures were grown under aerobic conditions on three different media. Staph. epidermidis was the most common predominant organism in both antibiotic groups, whereas E. coli and Klebsiella were the most common Gram-negative bacteria isolated. Seventeen % of these Gram-negative species were resistant to colistin and 9% to gentamicin, with a gradual increase occurring during the 3-wk period. On the basis of 980 positive cultures from all sites in babies in the nursery during the 11-month study, E. coli sensitivity to kanamycin and gentamicin ranged between 92% and 100% except for one month midway through the study when sensitivity to kanamycin was at 80% and then returned to the 92-100% range. Klebsiella sensitivity to both aminoglycosides remained greater than 95% throughout. The incidence of neonatal sepsis remained consistent at seven to nine per 1000 live births during the study. One baby of 50 in the gentamicin group developed necrotizing enterocolitis at 5 wk of age; 0/50 in the colistin group had necrotizing enterocolitis (not significant).

Topics: Colistin; Drug Resistance, Microbial; Enterocolitis, Pseudomembranous; Escherichia coli; Feces; Gentamicins; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Klebsiella; Risk; Staphylococcus