ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2019
Fluoroquinolone Prophylaxis Selects for Meropenem-nonsusceptible Pseudomonas aeruginosa in Patients With Hematologic Malignancies and Hematopoietic Cell Transplant Recipients.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 68 citations in OpenAlex.
- Guideline
- Global epidemiology of carbapenem-resistantJAC-antimicrobial resistance · 2026Review
- Effect of Quinolone Prophylaxis Discontinuation During Pre-engraftment Neutropenia on Incidence, Mortality, and Etiology of Bloodstream Infections in Hematopoietic Stem-cell Transplant Recipients: A Systematic Review and Meta-analysis.Open forum infectious diseases · 2026Article
- Role of R5 pyocin in the predominance of high-risk Pseudomonas aeruginosa isolates.Microbiological research · 2025Article
- Epidemiology of hospital-acquired bloodstream infections in haemato-oncology patients in Geneva, Switzerland.Infection · 2025Article
- The Impact of Antibiotic Prophylaxis on Antibiotic Resistance, Clinical Outcomes, and Costs in Adult Hemato-Oncological and Surgical Patients: A Systematic Review and Meta-Analysis.Antibiotics (Basel, Switzerland) · 2025Review
- Low rate of infectious mortality omitting fluoroquinolone prophylaxis in high-risk hematological patients, a single centre experience.Frontiers in microbiology · 2025Article
- The fitness connection of antibiotic resistance.Frontiers in microbiology · 2025Article
- Article
- Patterns of fluoroquinolone utilization and resistance in a tertiary care hospital: a retrospective cross-sectional analysis study from a developing country.BMC infectious diseases · 2024Article
- Clinical and Microbiological Characteristics of Febrile Neutropenia During Induction Chemotherapy in Adults With Acute Leukemia.Cancer reports (Hoboken, N.J.) · 2024Article
- Impact of Discontinuing Levofloxacin Prophylaxis on Bloodstream Infections in Neutropenic Hematopoietic Stem Cell Transplantation Patients.Antibiotics (Basel, Switzerland) · 2022Article
- Review
- Use of the Hollow-Fiber Infection Model to Measure the Effect of Combination Therapy of Septic Shock Exposures of Meropenem and Ciprofloxacin against Intermediate and Resistant Pseudomonas aeruginosa Clinical Isolates.Antimicrobial agents and chemotherapy · 2022Article
- Long-Term Dominance of Carbapenem-Non-SusceptibleFrontiers in cellular and infection microbiology · 2022Article
- Multidrug-resistantFrontiers in cellular and infection microbiology · 2022Article
- Can a Simple Stool Swab Predict Bacteremia in High-Risk Hematopoietic Cell Transplant Recipients?Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2021Article
- Emergence of non-susceptibility during persistentJAC-antimicrobial resistance · 2021Article
- Early antimicrobial prophylaxis in autologous stem cell transplant recipients: Conventional versus an absolute neutrophil count-driven approach.Transplant infectious disease : an official journal of the Transplantation Society · 2021Observational
- Characteristics of gram-negative bacteremia during febrile neutropenia among allogeneic hematopoietic stem cell transplant recipients on levofloxacin prophylaxis.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2021Article
Corrections and comments
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Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundIn Pseudomonas aeruginosa, fluoroquinolone exposure promotes resistance to carbapenems through upregulation of efflux pumps and transcriptional downregulation of the porin OprD. Evidence of this effect among hematologic malignancy (HM) patients or hematopoietic cell transplant (HCT) recipients receiving fluoroquinolone prophylaxis for neutropenia is lacking.
methodsWe retrospectively evaluated episodes of P. aeruginosa bloodstream infections in HM patients or HCT recipients over a 7-year period at our institution. We determined the association of fluoroquinolone prophylaxis at the time of infection with meropenem susceptibility of P. aeruginosa breakthrough isolates and risk factors for meropenem nonsusceptibility. Whole-genome sequencing (WGS) and phenotypic assessments of meropenem efflux pump activity were performed on select isolates to determine the mechanisms of meropenem resistance.
resultsWe analyzed 55 episodes of P. aeruginosa bacteremia among 51 patients. Breakthrough bacteremia while on fluoroquinolone prophylaxis was associated with nonsusceptibility to meropenem, but not to antipseudomonal β-lactams or aminoglycosides. The receipt of fluoroquinolone prophylaxis was independently predictive of bacteremia with a meropenem-nonsusceptible isolate. All meropenem-nonsusceptible isolates analyzed by WGS contained oprD inactivating mutations, and all meropenem-nonsusceptible isolates tested demonstrated reductions in the meropenem minimum inhibitory concentration in the presence of an efflux pump inhibitor. A phylogenetic analysis based on WGS revealed several clusters of closely related isolates from different patients.
conclusionsFluoroquinolone prophylaxis in HM patients and HCT recipients is associated with breakthrough bacteremia with meropenem-nonsusceptible P. aeruginosa strains, likely due to both mutations increasing efflux pump activity and the epidemiology of P. aeruginosa bloodstream infections in our patient population.
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