Fluoroquinolone Resistance in Bacteremic and Low-Risk Febrile Neutropenic Patients with Cancer

Strategic Insights -

A study conducted by researchers at Fudan University in Shanghai, China, has raised concerns about the effectiveness of fluoroquinolone-based oral treatment for low-risk febrile neutropenic patients with cancer. The study, published in BMC Cancer, found that a significant number of Escherichia coli isolates from these patients showed high levels of resistance to fluoroquinolone. This is in contrast to previous studies conducted in Western countries, where fluoroquinolone sensitivity was high.

Key Takeaways:

  • The study analyzed 38 patients with febrile neutropenia, solid tumor or lymphoma, and a MASCC score of over 20, who had positive blood cultures between January 2010 and December 2013 in two large Chinese cancer centers.
  • The majority of the monomicrobial isolates (74%) were Escherichia coli, with 13 out of 28 isolates (46%) showing resistance to fluoroquinolone.
  • The study highlighted the need for further validation in prospective clinical trials in countries where antibiotic resistance is prevalent to ensure appropriate antibiotic administration.
  • The National Comprehensive Cancer Network (NCCN) guideline recommends fluoroquinolone-based oral treatment for low-risk febrile neutropenic patients with a MASCC score of over 20, but this recommendation is based on evidence from Western countries.
  • The study suggests that fluoroquinolone resistance may be a concern in low-income countries like China, where antibiotic resistance is becoming prevalent.

Statistics:

  • 38 patients with febrile neutropenia were included in the study.
  • 74% of the monomicrobial isolates were Escherichia coli.
  • 13 out of 28 Escherichia coli isolates (46%) were resistant to fluoroquinolone.
  • 14 out of all 38 positive cultures (37%) showed resistance to fluoroquinolone.

Sources:

  • Fluoroquinolone resistance in bacteremic and low risk febrile neutropenic patients with cancer. BMC Cancer, 2015;15():28-32.
  • Biomed Central Ltd, 236 Grays Inn Rd, Floor 6, London WC1X 8HL, England.
  • S. Zhang, Fudan University, Shanghai Canc Center, Dept. of Clin Lab, Shanghai 200433, People's Republic of China.
  • Q. Wang, Y. Ling, and X.C. Hu (Fudan University, Shanghai, China).