BACTEREMIA AND FUNGEMIA OCCURRING DURING ANTIMICROBIAL PROPHYLAXIS WITH OFLOXACIN IN CANCER-PATIENTS - RISK-FACTORS, ETIOLOGY AND OUTCOME

The authors analyzed 27 breakthrough bacteremias occurring during oflo xacin prophylaxis in afebrile neutropenia over 7 years in 9989 admissi ons and 979 bacteremic and fungemic episodes in a National Cancer Cent er in Bratislava, Slovak Republic. The most frequently isolated organi sms in breakthrough bacteremias were gram-positive (71.3%), mainly coa gulase-negative staphylococci (41.3%), enterococci (9.2%) and Coryneba cteria (9.2%), followed by gram-negative rods Pseudomonas aeruginosa ( 13.2%) and Stenotrophomonas maltophilia (9.2%). The outcome of breakth rough bacteremias during ofloxacin prophylaxis was not associated with the underlying disease, neutropenia, catheter insertion or resistance , but only with multiple risk factors. A higher failure rate was obser ved in those patients having a catheter infected with a resistant orga nism and during neutropenia. No patients with Hickman catheter were in cluded in the study. Patients with mixed breakthrough bacteremia due t o gram-negative and gram-positive organisms had higher failure rates t han those with monomicrobial bacteremia. Catheter extraction and rapid institution of intravenous antibiotics in combination should be admin istered in breakthrough bacteremia.