{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T11:10:24Z","timestamp":1773400224511,"version":"3.50.1"},"reference-count":19,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T00:00:00Z","timestamp":1642118400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Bloodstream infections (BSIs) cause morbidity and mortality in pediatric patients with leukemia. Antibiotic prophylaxis during periods of chemotherapy\u2010induced neutropenia may reduce the incidence of BSIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Procedure<\/jats:title><jats:p>A levofloxacin prophylaxis guideline was implemented for pediatric patients with acute myeloid leukemia and relapsed acute lymphoblastic leukemia. We conducted a retrospective cohort study over 4\u00a0years (2\u00a0years pre and 2\u00a0years post implementation) of the practice guideline to assess the impact on central line\u2010associated bloodstream infections (CLABSI) and BSI events. Secondary outcomes included incidence of <jats:italic>Clostridioides difficile<\/jats:italic>\u2010associated diarrhea, bacteremia due to multidrug\u2010resistant organisms (MDRO), and bacteremia due to levofloxacin nonsusceptible organisms. STATA was used for data analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010three and 72 patients met inclusion criteria for the pre\u2010 and postimplementation cohorts, respectively. Demographics were similar between the groups. We observed 60 BSI events in the pre\u2010group versus 49 events in the post\u2010group (<jats:italic>p<\/jats:italic>\u00a0=\u00a0.1). Bacteremia due to Gram\u2010negative rods (risk ratio [RR] 0.37 [0.21, 0.66], <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001) and National Healthcare Safety Network (NHSN) CLABSIs (RR 0.62 [0.44, 0.89], <jats:italic>p<\/jats:italic>\u00a0=\u00a0.01) were significantly reduced in the postimplementation group. The incidences of <jats:italic>C. difficile<\/jats:italic>\u2010associated diarrhea and MDRO bacteremia were similar between groups. However, we observed an increase in the incidence of BSI due to Gram\u2010negative rods that were nonsusceptible to levofloxacin (RR 3.38 [0.72, 6.65], <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Following implementation of a levofloxacin prophylaxis guideline, we observed a significant decrease in BSIs due to Gram\u2010negative rods and NHSN CLABSIs. Vigilant monitoring of outcomes post guideline implementation is critical to track emergence of resistant organisms.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29525","type":"journal-article","created":{"date-parts":[[2022,1,14]],"date-time":"2022-01-14T12:55:15Z","timestamp":1642164915000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Levofloxacin prophylaxis for pediatric leukemia patients: Longitudinal follow\u2010up for impact on health care\u2010associated infections"],"prefix":"10.1002","volume":"69","author":[{"given":"Andrea","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Infection Control and Prevention Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra M.","family":"Stevens","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Hematology Oncology Baylor College of Medicine  Houston Texas USA"},{"name":"Texas Children's Cancer Center Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julienne","family":"Brackett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Hematology Oncology Baylor College of Medicine  Houston Texas USA"},{"name":"Texas Children's Cancer Center Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucila","family":"Marquez","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention Texas Children's Hospital  Houston Texas USA"},{"name":"Department of Pediatrics, Division of Infectious Diseases Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2657-039X","authenticated-orcid":false,"given":"Catherine E.","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention Texas Children's Hospital  Houston Texas USA"},{"name":"Department of Pediatrics, Division of Infectious Diseases Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah E.","family":"Sauer","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5854-6749","authenticated-orcid":false,"given":"Judith R.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Department of Infection Control and Prevention Texas Children's Hospital  Houston Texas USA"},{"name":"Department of Pediatrics, Division of Infectious Diseases Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,1,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir073"},{"key":"e_1_2_10_3_1","unstructured":"CDC.Intravascular Catheter\u2010related Infection (BSI). Guidelines for the Prevention of Intravascular Catheter\u2010Related Infections.CDC;2011. Accessed January 4 2021.https:\/\/www.cdc.gov\/infectioncontrol\/guidelines\/bsi\/index.html"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-0582"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2017.188"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0000000000001950"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2014.38"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044097"},{"issue":"1","key":"e_1_2_10_9_1","first-page":"CD004386","article-title":"Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy","volume":"1","author":"Gafter\u2010Gvili A","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.2395"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.12512"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25463"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000591"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26952"},{"key":"e_1_2_10_15_1","unstructured":"CDC.Bloodstream Infection Event (Central Line\u2010Associated Bloodstream Infection and Non\u2010central Line Associated Bloodstream Infection). Accessed January 4 2021.https:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/4psc_clabscurrent.pdf"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00158"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000000058"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2017.08.045"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1086\/340352"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.44.1.160-165.2006"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.29525","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pbc.29525","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pbc.29525","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T04:49:11Z","timestamp":1692852551000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pbc.29525"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,14]]},"references-count":19,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1002\/pbc.29525"],"URL":"https:\/\/doi.org\/10.1002\/pbc.29525","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,14]]},"assertion":[{"value":"2021-08-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-01-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e29525"}}