{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:54:28Z","timestamp":1785434068299,"version":"3.56.0"},"reference-count":40,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T00:00:00Z","timestamp":1778544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["CA51880"],"award-info":[{"award-number":["CA51880"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]},{"award":["CA51880"],"award-info":[{"award-number":["CA51880"]}],"id":[{"id":"https:\/\/ror.org\/02t771148","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","award":["U01AI187297"],"award-info":[{"award-number":["U01AI187297"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]},{"award":["U01AI187297"],"award-info":[{"award-number":["U01AI187297"]}],"id":[{"id":"https:\/\/ror.org\/043z4tv69","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Hackensack Meridian Health Care"},{"id":[{"id":"https:\/\/ror.org\/04p5zd128","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Fluoroquinolone prophylaxis during autologous stem cell transplantation (aSCT) reduces the risk of fever but raises the risk of bloodstream infection (BSI) with fluoroquinolone-resistant Enterobacterales (FRE). We performed a prospective cohort study to detect the presence and potential gain or loss of colonic FRE colonization using serial sampling before and after aSCT in a uniform population of patients with a diagnosis of multiple myeloma. Methods: Eligible subjects underwent aSCT after conditioning with dose-intense melphalan, 200 mg\/m2. Peri-anal swabs were obtained before aSCT, upon hospital discharge, and 12\u201316 weeks after transplantation. Samples were cultured in tryptic soy broth supplemented with either ciprofloxacin or ceftriaxone with subsequent plating onto selective chromogenic agar designed to facilitate recovery and differentiation of Enterobacterales. Results: FRE colonization on pre-transplant sampling was detected for 23 of 117 subjects (19.7%) and 29 of 98 (29.6%) subjects at hospital discharge after a course of fluoroquinolone (116\/117 subjects) prophylaxis (p &lt; 0.001) and 28 of 92 (30.4%) subjects at 12\u201316 weeks. Including all three sampling time points, 48 of 117 subjects (41.0%) tested positive for FRE colonization. In total, 58 of the 90 FRE isolates (64.4%) from 48 subjects expressed extended-spectrum beta-lactamase (ESBL). Three FRE-colonized subjects developed FRE BSI. Bloodstream isolates for two subjects were identical to the organisms identified on pre-transplant sampling. Conclusions: We hypothesize that fluoroquinolone prophylaxis of subjects with undetected low levels of FRE colonization allows the expansion of the FRE population, placing subjects at risk of BSI with fluoroquinolone-resistant (and ESBL-expressing) Enterobacterales. Pre-transplant testing for FRE colonization permits patient-specific design of prophylactic and empiric antibiotic regimens.<\/jats:p>","DOI":"10.3390\/cancers18101566","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T12:33:37Z","timestamp":1778589217000},"page":"1566","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fluoroquinolone Prophylaxis Uncovers High Prevalence Rates of Fluoroquinolone-Resistant Enterobacterales Colonization in Multiple Myeloma Autologous Transplant Patients: A Prospective Cohort Study"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5187-8225","authenticated-orcid":false,"given":"Chintan","family":"Patel","sequence":"first","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8209-8922","authenticated-orcid":false,"given":"Austin J.","family":"Terlecky","sequence":"additional","affiliation":[{"name":"Center for Discovery and Innovation, 111 Ideation Road, Nutley, NJ 07110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Baker","sequence":"additional","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6478-5690","authenticated-orcid":false,"given":"Tara","family":"Lozy","sequence":"additional","affiliation":[{"name":"Center for Discovery and Innovation, 111 Ideation Road, Nutley, NJ 07110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly K.","family":"Yen","sequence":"additional","affiliation":[{"name":"Center for Discovery and Innovation, 111 Ideation Road, Nutley, NJ 07110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navjot","family":"Kaur","sequence":"additional","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Machere","sequence":"additional","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa","family":"Ali","sequence":"additional","affiliation":[{"name":"Lombardi Comprehensive Cancer Center, 3800 Reservoir Road NW, Washington, DC 20007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Cho","sequence":"additional","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele L.","family":"Donato","sequence":"additional","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pashna N.","family":"Munshi","sequence":"additional","affiliation":[{"name":"Lombardi Comprehensive Cancer Center, 3800 Reservoir Road NW, Washington, DC 20007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-131X","authenticated-orcid":false,"given":"Barry N.","family":"Kreiswirth","sequence":"additional","affiliation":[{"name":"Center for Discovery and Innovation, 111 Ideation Road, Nutley, NJ 07110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3299-835X","authenticated-orcid":false,"given":"Scott D.","family":"Rowley","sequence":"additional","affiliation":[{"name":"John Theurer Cancer Center, 92 Second Street, Hackensack, NJ 07601, USA"},{"name":"Lombardi Comprehensive Cancer Center, 3800 Reservoir Road NW, Washington, DC 20007, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,12]]},"reference":[{"key":"ref_1","first-page":"289","article-title":"Historical perspective of high-dose therapy followed by autologous stem cell transplantation in multiple myeloma","volume":"148","author":"Cohen","year":"2025","journal-title":"Acta Haematol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3069","DOI":"10.1093\/jac\/dkac283","article-title":"Impact of mucositis on oral bioavailability and systemic exposure of ciprofloxacin gram-negative infection prophylaxis in patients with haematological malignancies","volume":"77","author":"Tonino","year":"2022","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_3","first-page":"579","article-title":"Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: Risk factors and the impact of mucositis severity","volume":"32","author":"Janssen","year":"2024","journal-title":"Support. Care Cancer"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/tid.12195","article-title":"Mucositis not neutropenia determines bacteremia among hematopoietic stem cell transplant recipients","volume":"16","author":"Herbers","year":"2014","journal-title":"Transpl. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Blijlevens, N.M.A., and de Mooij, C.E.M. (2023). Mucositis and infection in hematology patients. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24119592"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1111\/j.1600-0609.2011.01724.x","article-title":"Degree of mucositis and duration of neutropenia are the major risk factors for early post-transplant febrile neutropenia and severe bacterial infections after reduced-intensity conditioning","volume":"88","author":"Facchini","year":"2012","journal-title":"Eur. J. Haematol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1007\/s00280-021-04273-7","article-title":"Translational model of melphalan-induced gut toxicity reveals drug-host-microbe interactions that drive tissue injury and fever","volume":"88","author":"Wardill","year":"2021","journal-title":"Cancer Chemother. Pharmacol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1007\/s00277-020-04378-8","article-title":"Gastrointestinal toxicity of high-dose melphalan in autologous hematopoietic stem cell transplantation: Identification of risk factors and a benchmark for experimental therapies","volume":"100","author":"Gordillo","year":"2021","journal-title":"Ann. Hematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/bjh.13113","article-title":"Mucosal barrier injury, fever and infection in neutropenic patients with cancer: Introducing the paradigm febrile mucositis","volume":"167","author":"Herbers","year":"2014","journal-title":"Br. J. Haematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4536","DOI":"10.1002\/cam4.2395","article-title":"Efficacy of antibiotic prophylaxis in patients with cancer and hematopoietic stem cell transplantation recipients: A systematic review of randomized trials","volume":"8","author":"Egan","year":"2019","journal-title":"Cancer Med."},{"key":"ref_11","first-page":"CD004386","article-title":"Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy","volume":"1","author":"Fraser","year":"2012","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society of Blood and Marrow Transplantation (2000). Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. Biol. Blood Marrow Transplant., 6, 7\u201383.","DOI":"10.1016\/S1083-8791(00)70002-4"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3043","DOI":"10.1200\/JCO.18.00374","article-title":"Antimicrobial prophylaxis for adult patients with cancer-related immunosuppression: ASCO and IDSA Clinical Practice Guideline Update","volume":"36","author":"Taplitz","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_14","unstructured":"(2026, April 10). Prevention and Treatment of Cancer-Related Infections, Version: 1.2026. Available online: www.nccn.org."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1182\/bloodadvances.2022008226","article-title":"Levofloxacin prophylaxis vs no prophylaxis in patients with neutropenia within an endemic country for carbapenem-resistant GNB","volume":"7","author":"Clerici","year":"2023","journal-title":"Blood Adv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1093\/cid\/ciab404","article-title":"Colonization with fluoroquinolone-resistant Enterobacterales decreases the effectiveness of fluoroquinolone prophylaxis in hematopoietic cell transplant recipients","volume":"73","author":"Satlin","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5507\/bp.2018.047","article-title":"Ciprofloxacin prophylaxis during autologous stem cell transplantation for multiple myeloma in patients with a high rate of fluoroquinolone-resistant gram-negative bacteria colonization","volume":"163","author":"Zavrelova","year":"2019","journal-title":"Biomed. Pap. Med. Fac. Univ. Palacky. Olomouc Czech. Repub."},{"key":"ref_18","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":"ref_19","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/j.bbmt.2015.06.017","article-title":"Impact of prophylactic levofloxacin on rates of bloodstream infection and fever in neutropenic patients with multiple myeloma undergoing autologous hematopoietic stem cell transplantation","volume":"21","author":"Satlin","year":"2015","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e198","DOI":"10.1016\/j.bbmt.2020.03.027","article-title":"Fluoroquinolone prophylaxis in autologous stem cell transplantation: Worthy of a second look","volume":"26","author":"Maakaron","year":"2020","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Guimar\u00e3es, T., Borges, I.C., Spad\u00e3o, F.S., Mariano, L., Nascimento, M.M., Higashino, H., Rossi, F., Rocha, V., and Costa, S.F. (2022). Impact of discontinuing levofloxacin prophylaxis on bloodstream infections in neutropenic hematopoietic stem cell transplantation patients. Antibiotics, 11.","DOI":"10.3390\/antibiotics11091269"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1093\/cid\/ciy363","article-title":"Colonization with levofloxacin-resistant extended-spectrum \u03b2-lactamase-producing Enterobacterales and risk of bacteremia in hematopoietic stem cell transplant recipients","volume":"67","author":"Satlin","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1159\/000535119","article-title":"Fluoroquinolone prophylaxis during conventional chemotherapy or hematopoietic stem cell transplantation for acute leukemia\u2014Pros and Cons","volume":"147","author":"Hoffman","year":"2024","journal-title":"Acta Haematol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1093\/cid\/cix646","article-title":"Antimicrobial resistance in gram-negative rods causing bacteremia in hematopoietic stem cell transplant recipients: Intercontinental prospective study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group","volume":"65","author":"Averbuch","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_25","unstructured":"Clinical and Laboratory Standard Institute (2020). CLSI M100TM Performance Standards for Anti-Microbial Susceptibility Testing, Clinical and Laboratory Standards Institute. [30th ed.]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1016\/j.bbmt.2015.08.030","article-title":"Engraftment syndrome after autologous stem cell transplantation: An update unifying the definition and management approach","volume":"21","author":"Cornell","year":"2015","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/hon.2813","article-title":"Prophylactic corticosteroid use prevents engraftment syndrome in patients after autologous stem cell transplantation","volume":"39","author":"Betticher","year":"2021","journal-title":"Hematol. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e0023422","DOI":"10.1128\/jcm.00234-22","article-title":"Comparison between perianal swab and stool specimens for detecting colonization with extended-spectrum beta-lactamase-producing and fluoroquinolone-resistant Enterobacterales","volume":"60","author":"Kubiak","year":"2022","journal-title":"J. Clin. Microbiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1128\/AAC.49.2.798-800.2005","article-title":"Test characteristics of perirectal and rectal swab compared to stool sample for detection of fluoroquinolone-resistant Escherichia coli in the gastrointestinal tract","volume":"49","author":"Lautenbach","year":"2005","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e4627","DOI":"10.1093\/cid\/ciaa068","article-title":"Compositional flux within the intestinal microbiota and risk for bloodstream infection with gram-negative bacteria","volume":"73","author":"Stoma","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1038\/s41597-021-00860-8","article-title":"Compilation of longitudinal microbiota data and hospitalome from hematopoietic cell transplantation patients","volume":"8","author":"Liao","year":"2021","journal-title":"Sci. Data"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1511","DOI":"10.1016\/j.bbmt.2019.04.007","article-title":"Gastrointestinal microbiome and mycobiome changes during autologous transplantation for multiple myeloma: Results of a prospective pilot study","volume":"25","author":"Salem","year":"2019","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"339079","DOI":"10.1016\/j.aca.2021.339079","article-title":"Advances in bacterial concentration methods and their integration in portable detection platforms: A review","volume":"1209","author":"Ezenarro","year":"2022","journal-title":"Anal. Chim. Acta"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Caliskan-Aydogan, O., and Alocilja, E.C. (2023). A Review of carbapenem resistance in Enterobacterales and its detection techniques. Microorganisms, 11.","DOI":"10.3390\/microorganisms11061491"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Kocsis, B., Szab\u00f3, D., and Sipos, L. (2025). Gut microbiome and intestinal colonization with multidrug-resistant strains of Enterobacterales: An interplay between microbial communities. Antibiotics, 14.","DOI":"10.3390\/antibiotics14090890"},{"key":"ref_36","first-page":"169","article-title":"Plasmid copy number and qnr gene expression in selection of fluoroquinolone-resistant Escherichia coli","volume":"66","author":"Kocsis","year":"2019","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1093\/cid\/cix690","article-title":"Gruppo Italiano Trapianto di Midollo Osseo (GITMO) and Associazione Microbiologi Clinici Italiani (AMCLI). Incidence, risk factors and outcome of pre-engraftment gram-negative bacteremia after allogeneic and autologous hematopoietic stem cell transplantation: An Italian Prospective Multicenter Survey","volume":"65","author":"Girmenia","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1016\/j.bbmt.2018.02.021","article-title":"Clinical impact of pretransplant multidrug-resistant gram-negative colonization in autologous and allogeneic hematopoietic stem cell transplantation","volume":"24","author":"Forcina","year":"2018","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.bbmt.2016.02.009","article-title":"Impact of gut colonization by antibiotic-resistant bacteria on the outcomes of allogeneic hematopoietic stem cell transplantation: A retrospective, single-center study","volume":"22","author":"Bilinski","year":"2016","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s10096-023-04548-2","article-title":"Intestinal colonization with multidrug-resistant Enterobacterales: Screening, epidemiology, clinical impact, and strategies to decolonize carriers","volume":"42","author":"Moradi","year":"2023","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1566\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T04:23:23Z","timestamp":1778732603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,12]]},"references-count":40,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18101566"],"URL":"https:\/\/doi.org\/10.3390\/cancers18101566","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,12]]}}}