What question did this study set out to answer?

This research aims to assess the impact of fluoroquinolone prophylaxis on infection rates and ICU admissions in patients with acute myeloid leukemia during induction chemotherapy.

February 17, 2026Open Access

Fluoroquinolone Prophylaxis Reduces Intensive Care Unit Admission and Clostridioides difficile Rates in Acute Myeloid Leukemia Induction Chemotherapy

Key Points

This research aims to assess the impact of fluoroquinolone prophylaxis on infection rates and ICU admissions in patients with acute myeloid leukemia during induction chemotherapy.
Retrospective review of adults with AML receiving induction chemotherapy from 2010 to 2022
Patients categorized by whether they received fluoroquinolone prophylaxis
Primary outcomes measured included CLABSI and MBI‐LCBI incidence
Secondary outcomes included ICU admission, neutropenic fever, and C. difficile infections
Microbiologic patterns analyzed based on prophylaxis status and time.
88 out of 195 patients (45.1%) received fluoroquinolone prophylaxis
ICU admission rates were significantly lower with prophylaxis (10.2% vs. 31.8%; p < 0.001)
C. difficile infection rates were also lower with prophylaxis (5.7% vs. 17.8%; p = 0.012)
No significant reduction in CLABSI or MBI‐LCBI rates was observed
Pseudomonas infections more common in patients without prophylaxis.

Abstract

ABSTRACT Background Patients with acute myeloid leukemia (AML) undergoing induction chemotherapy are at high‐risk of bloodstream infections, including central line‐associated bloodstream infections (CLABSI) or mucosal barrier injury‐related infections (MBI‐LCBI). The impact of fluoroquinolone (FQ) prophylaxis on MBI‐LCBI, Clostridioides difficile , and intensive care unit (ICU) outcomes in this population remains unclear. Methods We retrospectively reviewed adults with AML receiving induction chemotherapy between 2010 and 2022. Patients were grouped by receipt of FQ prophylaxis. Primary outcomes were incidence of CLABSI, and MBI‐LCBI. Secondary outcomes included neutropenic fever, ICU admission, length of stay, and C. difficile infection. Microbiologic patterns were analyzed by time and prophylaxis status. Results Among 195 patients, 88 (45.1%) received FQ prophylaxis. CLABSI rates were 8.0% with prophylaxis versus 15.0% without ( p = 0.132), and MBI‐LCBI rates were 11.4% versus 15.0% ( p = 0.463). ICU admission was significantly lower with prophylaxis (10.2% vs. 31.8% ; p < 0.001). C. difficile infection was also less frequent among those receiving prophylaxis (5.7% vs. 17.8%; p = 0.012). Neutropenic fever rates were similar between groups. CLABSI isolates were primarily skin flora and staphylococcal species, whereas MBI‐LCBI isolates were exclusively enteric flora, increasingly involving Gram‐negative rods over time. Pseudomonas infections were more frequent among patients without prophylaxis. Conclusions In this cohort, FQ prophylaxis did not significantly reduce bloodstream infections but was associated with fewer ICU admissions and lower rates of C. difficile infection. These findings further support the use of FQ prophylaxis with minimal concern for exacerbation of C. difficile rates. It further highlights ongoing risk from enteric translocation despite prophylaxis.

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eJHaem

Institutions

Augusta University

National Cancer Center of Georgia

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