{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T10:07:38Z","timestamp":1789726058749,"version":"4.0.1"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Infectious complications and antimicrobial resistance (AMR) are leading causes of morbidity and non-relapse mortality (NRM) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). The BATMO protocol, implemented in 2019, removed fluoroquinolone prophylaxis and introduced a personalized, stewardship-based antimicrobial approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 323 allo-HSCT recipients transplanted between 2016 and 2023 at a single center, comparing outcomes in patients before (n = 115) and after (n = 208) BATMO implementation. Primary endpoints included overall survival (OS), NRM, incidence and microbiology of bloodstream infections (BSIs), antimicrobial resistance trends, and carbapenem use. Kaplan-Meier and cumulative incidence methods were employed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Despite a significant increase in 30-day Gram-negative BSI incidence post-BATMO (24% vs 15%, P = .03), OS and NRM were similar between the two cohorts. Notably, the post-BATMO cohort included a substantially higher proportion of high-risk transplants, with a marked increase in haploidentical procedures and broader use of post-transplant cyclophosphamide. Interestingly, fluoroquinolone-resistant E. coli strains declined from 100% to 46% (P = .003), and overall Gram-negative resistance dropped from 75% to 36% (P = .006). Use of carbapenems remained unchanged (43% vs 53%, P = .1).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The BATMO protocol demonstrates that withdrawal of fluoroquinolone prophylaxis and implementation of a targeted antimicrobial strategy can reduce resistance without compromising transplant outcomes. These findings support the long-term safety and efficacy of stewardship-based approaches in allo-HSCT.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag511","type":"journal-article","created":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T11:32:30Z","timestamp":1786275150000},"source":"Crossref","is-referenced-by-count":0,"title":["Fluoroquinolone-Free Prophylaxis and Impact on Bacterial Infections, Resistance, and Survival in Allo-HSCT: 5-Year Follow-up of the BATMO Protocol (Best Anti-microbical Therapy Trapianto di Midollo Osseo)"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4218-4170","authenticated-orcid":false,"given":"Daniele","family":"Avenoso","sequence":"first","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Farina","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Ferri","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Masina","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liana","family":"Signorini","sequence":"additional","affiliation":[{"name":"Unit of Vaccinations and Infectious Diseases Surveillance, ASST Garda, 25015 Desenzano D\/G , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Lorenzotti","sequence":"additional","affiliation":[{"name":"Unit of Infectious and Tropical Diseases, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Van Hauwermeiren","sequence":"additional","affiliation":[{"name":"Unit of Infectious and Tropical Diseases, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biagio Francesco","family":"Canino","sequence":"additional","affiliation":[{"name":"Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia, ASST Spedali Civili , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Corbellini","sequence":"additional","affiliation":[{"name":"Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia, ASST Spedali Civili , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Caccuri","sequence":"additional","affiliation":[{"name":"Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia, ASST Spedali Civili , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Magliano","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia 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University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]},{"name":"Centro di Ricerca Emato-Oncologica AIL (CREA), ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Re","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]},{"name":"Centro di Ricerca Emato-Oncologica AIL (CREA), ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2177-2064","authenticated-orcid":false,"given":"Alessandro","family":"Leoni","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]},{"name":"Centro di Ricerca Emato-Oncologica AIL (CREA), ASST Spedali Civili di Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5178-566X","authenticated-orcid":false,"given":"Arnaldo","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Molecular and Translational Medicine, Institute of Microbiology, University of Brescia, ASST Spedali Civili , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Russo","sequence":"additional","affiliation":[{"name":"Unit of Blood Diseases and Bone Marrow Transplantation, Department of Clinical and Experimental Science, University of Brescia, ASST Spedali Civili di Brescia , Brescia 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hematologic malignancies","volume":"40","author":"Reuter","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2026091805320484300_ofag511-B6","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jtct.2020.10.001","article-title":"American society of transplantation and cellular therapy series, 1: enterobacterales infection prevention and management after hematopoietic cell transplantation","volume":"27","author":"Satlin","year":"2021","journal-title":"Transplant Cell Ther"},{"key":"2026091805320484300_ofag511-B7","doi-asserted-by":"crossref","DOI":"10.1111\/tid.14152","article-title":"Fluoroquinolone prophylaxis in patients with neutropenia at high risk of serious infections: exploring pros and cons","volume":"25","author":"Singh","year":"2023","journal-title":"Transpl Infect Dis"},{"key":"2026091805320484300_ofag511-B8","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1097\/QCO.0000000000001114","article-title":"The role of antibacterial prophylaxis in high-risk neutropenia: benefits, risks, and current perspectives","volume":"38","author":"Douglas","year":"2025","journal-title":"Curr Opin Infect Dis"},{"key":"2026091805320484300_ofag511-B9","doi-asserted-by":"crossref","first-page":"106571","DOI":"10.1016\/j.jinf.2025.106571","article-title":"Epidemiology of resistant bacterial infections in patients with hematological malignancies or undergoing hematopoietic cell transplantation in Europe: a systematic review by the European conference on infections in leukemia (ECIL)","volume":"91","author":"Baccelli","year":"2025","journal-title":"J Infect"},{"key":"2026091805320484300_ofag511-B10","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13756-015-0059-2","article-title":"Community acquired multi-drug resistant clinical isolates of Escherichia coli in a tertiary care center of Nepal","volume":"4","author":"Ansari","year":"2015","journal-title":"Antimicrob Resist Infect 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