The impact of fluoroquinolone-resistant enterobacterales colonization on fluoroquinolone prophylaxis efficacy in hematopoietic cell transplant recipients

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INTRODUCTION: Hematopoietic cell transplantation (HCT) carries a high infection risk, especially pre-engraftment. Fluoroquinolone (FQ) prophylaxis is common, but rising FQ-resistant Enterobacterales (FQRE) rates may limit its effectiveness. This study evaluated febrile neutropenia, bacteremia, and mortality in HCT patients based on FQ prophylaxis and FQRE colonization. METHODS: A retrospective analysis of HCT recipients at a tertiary center in Lebanon (2017–2022) was performed. Patients receiving FQ prophylaxis during neutropenia were compared with those who did not. FQRE colonization was monitored through weekly perianal swabs post-transplant. RESULTS: Of 156 HCT recipients (mean age 54 years; 61% males), 73.1% received FQ prophylaxis, and 39% had FQRE colonization. Febrile neutropenia occurred in 86%, more frequently in non-prophylaxis and FQRE-colonized patients, though prophylaxis delayed its onset within 10 days post-transplant. Bacteremia affected 39.1% of 64 eligible patients, with lower rates in the prophylaxis group (35.7% vs. 62.5%, p = 0.02). Escherichia coli and coagulase-negative staphylococci predominated. All-cause mortality was 3.8%, with pneumonia and Clostridioides difficile infections in 5.1% and 3.2%, respectively; prophylaxis showed non-significant reductions in these outcomes. CONCLUSION: FQ prophylaxis reduced febrile neutropenia and bacteremia in HCT recipients, including those colonized with FQRE. Larger studies are needed to confirm its effects on multiple outcomes. CLINICAL TRIAL NUMBER: Not applicable.

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