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. 2019 May 31;6(7):ofz252.
doi: 10.1093/ofid/ofz252. eCollection 2019 Jul.

Impact of Levofloxacin for the Prophylaxis of Bloodstream Infection on the Gut Microbiome in Patients With Hematologic Malignancy

Matthew Ziegler  1 , Jennifer H Han  1   2   3 , Daniel Landsburg  4 , David Pegues  1   3 , Emily Reesey  1 , Cheryl Gilmar  3 , Theresa Gorman  4 , Kristen Bink  4 , Amy Moore  4 , Brendan J Kelly  1   2 ; CDC Prevention Epicenters Program
Affiliations

Impact of Levofloxacin for the Prophylaxis of Bloodstream Infection on the Gut Microbiome in Patients With Hematologic Malignancy

Matthew Ziegler et al. Open Forum Infect Dis. .

Abstract

Background: We evaluated the differential impact of levofloxacin administered for the prophylaxis of bloodstream infections compared with broad-spectrum beta-lactam (BSBL) antibiotics used for the treatment of neutropenic fever on the gut microbiome in patients with hematologic malignancy.

Methods: Stool specimens were collected from patients admitted for chemotherapy or stem cell transplant in the setting of the evaluation of diarrhea from February 2017 until November 2017. Microbiome characteristics were compared among those exposed to levofloxacin prophylaxis vs those who received BSBL antibiotics.

Results: Sixty patients were included, most with acute myeloid leukemia (42%) or multiple myeloma (37%). The gut microbiome of patients with BSBL exposure had significantly reduced Shannon's alpha diversity compared with those without (median [interquartile range {IQR}], 3.28 [1.73 to 3.71] vs 3.73 [3.14 to 4.31]; P = .01). However, those with levofloxacin exposure had increased alpha diversity compared with those without (median [IQR], 3.83 [3.32 to 4.36] vs 3.32 [2.35 to 4.02]; P = .03). Levofloxacin exposure was also associated with a trend toward lower risk of dominance of non-Bacteroidetes genera compared with those without levofloxacin exposure (3 [14%] vs 15 [38%]; P = .051).

Conclusions: The impact of antibiotics on the gut microbiome varies by class, and levofloxacin may disrupt the gut microbiome less than BSBLs in this patient population.

Keywords: antibiotic prophylaxis; hematologic neoplasms; levofloxacin; microbiota.

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Figures

Figure 1.
Figure 1.
Flow diagram of patient samples and antibiotic exposure in the 7 days before collection. Abbreviation: BSBL, broad-spectrum beta-lactam.
Figure 2.
Figure 2.
Proportion of bacterial phyla by antibiotic exposure. Abbreviation: BSBL, broad-spectrum beta-lactam.
Figure 3.
Figure 3.
Principal coordinate analysis. Abbreviation: BSBL, broad-spectrum beta-lactam.
See this image and copyright information in PMC

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