Infectious complications after hematopoietic stem cell transplantation: current status and future perspectives in Korea

Cho, Sung-Yeon; Lee, Hyeon-Jeong; Lee, Dong-Gun

Prophylaxis plays an important role during the pre-engraftment phase ( Table 2 ). Oral fluoroquinolone prophylaxis can reduce febrile neutropenic episodes and related mortality in allogeneic HSCT recipients [33, 34] . According to the guidelines from the Infectious Diseases Society of America and Infectious Diseases Working Party of the German Society of Hematology and Oncology, ciprofloxacin and levofloxacin are equally effective, but levofloxacin may be more effective in terms of broader coverage of viridans streptococci when oral mucositis is present [15, 35] . Although fluoroquinolone prophylaxis has led to an increase in the frequency of drug-resistant (including quinolones) pathogens, the benefit reportedly outweighs the risk [33] . Fluoroquinolone prophylaxis decreased the rate of identification of P. aeruginosa [22] . However, fluoroquinolone prophylaxis is reportedly correlated with resistance development and Clostridium difficile-associated diarrhea [36] [37] [38] [39] [40] [41] . Moreover, fluoroquinolone prophylaxis may reduce the rate of bloodstream infections, but not the overall mortality rate [42] . Therefore, the benefit of routine fluoroquinolone prophylaxis should be weighed against its toxicity and effect on the local epidemiology.