Incomplete recovery of the fecal flora of hematological patients with neutropenia and repeated fluoroquinolone prophylaxis

Figures & data

Table 1 Detection of fluoroquinolone-susceptible and/or resistant bacteria in the fecal flora of hematological patients with neutropenia and repeated quinolone prophylaxis

Each cycle	Quinolone-susceptible Enterobacteriaceae		P-value	Quinolone-resistant CNS and/or Enterococci		P-value
	Before prophylaxis	After prophylaxis		Before prophylaxis	After prophylaxis
	No. of samples / total samples (%)	No. of samples / total samples (%)		No. of samples / total samples (%)	No. of samples / total samples (%)
Cycle 1, n = 35	28 / 35 (80.0)	0 / 35 (0.0)	< 0.001	8 / 35 (22.9)	25 / 35 (71.4)	< 0.001
Cycle >2, n = 33	23 / 33 (69.7)	0 / 33 (0.0)	< 0.001	20 / 33 (60.6)	32 / 33 (97.0)	< 0.001
Cycle 2, n = 21	14 /21 (66.7)	0 / 21 (0.0)	< 0.001	11 / 21 (52.4)	20 / 21 (95.2)	0.004
Cycle >3, n = 12	9/12 (75.0)	0 / 12 (0.0)	< 0.001	9 / 12 (75.0)	12 / 12 (100.0)	0.217

Abbreviation: CNS, coagulase negative staphylococci.

Table 2 Related factors for the detection of quinolone-susceptible Enterobacteriaceae and quinolone-resistant CNS and/or Enterococci before the prophylaxis of cycle >2

Variable		Quinolone-susceptible Enterobacteriaceae before prophylaxis (cycle >2)		P-value	Quinolone-resistant CNS and/or Enterococci before prophylaxis (cycle >2)		P-value
		Detection (n = 23)	No detection (n = 10)		Detection (n = 20)	No detection (n = 13)
		No. of samples / total samples (%)	No. of samples / total samples (%)		No. of samples / total samples (%)	No. of samples / total samples (%)
High-intensity chemotherapy at last cycle	n = 23	16 / 23 (69.6)	7 / 10 (70.0)	1.0	15 / 20 (75.0)	8 / 13 (61.5)	0.4611
TMP-SMX prophylaxis at last cycle	n = 18	11 / 23 (47.8)	7 / 10 (70.0)	0.2828	13 / 20 (65.0)	5 / 13 (38.5)	0.1686
Antimicrobial therapy except for quinolone prophylaxis at last cycle	n = 14	12/23 (52.2)	2 / 10 (20.0)	0.1312	10 / 20 (50.0)	4 / 13 (30.8)	0.3095
Duration of quinolone prophylaxis at last cycle
within 7 days	n = 12	8 / 23 (34.8)	4 / 10 (40.0)	1.0	7 / 20 (35.0)	5 / 13 (38.5)	1.0
within 14 days	n = 27	21 / 23 (91.3)	6 / 10 (60.0)	0.0534	16 / 20 (80.0)	11 / 13 (84.6)	1.0
Duration from final antimicrobial therapy to sample collection
within 30 days	n = 23	13 / 23 (56.5)	10 / 10 (100.0)	0.0148	16 / 20 (80.0)	7 / 13 (53.8)	0.1393
>31 days	n = 10	10 / 23 (43.5)	0 / 10 (0.0)	0.0148	4 / 20 (20.0)	6 / 13 (46.2)	0.1393

Abbreviations: CNS, coagulase negative staphylococci; TMP-SMX, trimethoprim-sulfamethoxazole.

Table 3 Detection history of fluoroquinolone-resistant and/or ESBL-producing E. coli in the fecal samples from patients with repeated quinolone prophylaxis.

Registration No.	1st prophylaxis		2nd prophylaxis		3rd prophylaxis		4th prophylaxis
	Before	After	Before	After	Before	After	Before	After
3, 4	None	ESBL ECa	ESBL EC	ESBL EC
8, 9, 10	QR EC	QR EC	QS EC	None	None	None
14, 15, 16, 17	QS EC	QR EC	QR EC	None	ESBL EC, QS EC	ESBL EC	ESBL EC, QR EC	ESBL EC, QR EC
20, 21	ESBL EC	ESBL EC	ESBL EC	ESBL EC
32, 33	QS EC	None	None	QR EC
37, 38	ESBL EC	None	ESBL EC	ESBL EC
47, 48	QR EC, QS EC	QR EC	QS EC	None

Note:

a ESBL EC strains were all resistant to quinolone.

Abbreviations: ESBL, extended-spectrum β-lactamase; EC, Escherichia coli; QR, quinolone-resistant; QS, quinolone-susceptible; ESBL EC, ESBL-producing EC.