Objective: To investigate the role of levofloxacin combined with recombinant human granulocyte colony-stimulating factor (G-CSF) or only G-CSF supportive therapy in preventing infection in autologous hematopoietic stem cell transplantation(ASCT), and to analyze the length of hospital stay, hospitalization cost and post-transplant survival of the patients.
Methods: A retrospective analysis was performed in the patients with hematological malignancies who accepted ASCT at our hospital from January 2012 to July 2022, the febrile neutropenia, the incidence of bacterial infection and the use rate of intravenous antibiotics in the levofloxacin+G-CSF group and only G-CSF support group during ASCT were observed. The length of hospital stay, total cost during hospitalization and survival after 90 days of transplantation between the two groups were compared.
Results: A total of 102 cases were included in this study, including 57 cases of multiple myeloma, 36 cases of acute leukaemia, 7 cases of lymphoma, 3 cases of myelodysplastic syndrome, 1 case of light chain amyloidosis, and 1 case of POEMS syndrome. 47 patients received levofloxacin+ G-CSF antibacterial prophylaxis, and 55 patients received G-CSF supportive therapy. In the levofloxacin+ G-CSF group, 40 cases (85.11%) developed febrile neutropenia, and 13 cases (27.66%) were confirmed as bacterial infection. In the G-CSF group, 44 cases (80.00%) developed febrile neutropenia, and 16 cases (29.09%) were bacterial infection. There was no statistically significant difference in the incidence of febrile neutropenia and bacterial infection between the two groups (χ2=0.46，P =0.50; χ2=0.03，P =0.87). The use rate of intravenous antibiotics in the levofloxacin+ G-CSF group was 85.11% (40/47), which was not statistically different from 85.45% (47/55) in the G-CSF group (χ2=0.04，P =0.84). The detection rates of levofloxacin-resistant bacteria in the levofloxacin+ G-CSF group and G-CSF group were 8.57% (3/35) and 21.43% (6/28), respectively, with no statistical difference (χ2=0.65, P >0.05). The median length and median cost of hospitalization in the levofloxacin+ G-CSF group and G-CSF group were 25 d vs 22 d and 78 216.24 yuan vs 80 724.38 yuan, with no statistically significant differences ( t =3.00，P =0.09; t =0.94，P =0.09). Within 90 days after transplantation, two cases (4.26%) died in the levofloxacin+ G-CSF group and one case (1.82%) died in the G-CSF group, with no statistically significant difference between the two groups (χ2=0.53，P =0.47).
Conclusion: Application of levofloxacin+ G-CSF showed no significant benefit compared to G-CSF support for the prevention of bacterial infections during ASCT.
题目: 左氧氟沙星联合G-CSF或仅用G-CSF支持疗法在预防自体造血干细胞移植感染中的作用.
目的: 探讨重组人粒细胞集落刺激因子（G-CSF）联合左氧氟沙星或仅用G-CSF支持疗法在预防自体造血干细胞移植感染中的作用，分析移植患者住院时间、住院费用及移植后生存情况。.
方法: 回顾性分析2012年1月至2022年7月于本院就诊的接受自体造血干细胞移植的恶性血液病患者，观察自体造血干细胞移植期间左氧氟沙星+G-CSF预防感染组和G-CSF支持组中性粒细胞缺乏伴发热、细菌感染发生率及静脉抗菌药物使用情况，并比较两组住院时间、住院期间总费用及移植90天后存活情况。.
结果: 102例患者纳入研究，其中多发性骨髓瘤54例，急性白血病36例，淋巴瘤7例，骨髓增生异常综合征3例，轻链型淀粉样变性1例，POEMS综合征1例。47例接受G-CSF+左氧氟沙星预防感染，55例接受G-CSF支持治疗。左氧氟沙星+G-CSF组中40例（85.11%）发生中性粒细胞缺乏伴发热，13例（27.66%）明确为细菌感染。G-CSF组中44例（80.00%）发生中性粒细胞缺乏伴发热，16例（29.09%）细菌感染。两组中性粒细胞缺乏伴发热和细菌感染发生率均无统计学差异（χ2=0.46，P =0.50；χ2=0.03，P =0.87）。左氧氟沙星+G-CSF组静脉抗菌药物使用率为85.11%（40/47），与G-CSF组的85.45%（47/55）比较无统计学差异（χ2= 0.04，P =0.84）。左氧氟沙星+G-CSF组与G-CSF组左氧氟沙星耐药菌的检出率分别为8.57%（3/35）和21.43%（6/ 28），无统计学差异（χ2=0.65，P >0.05）。左氧氟沙星+G-CSF与G-CSF组患者住院中位时间为25 d vs 22 d，住院中位费用为78 216.24元 vs 80 724.38元，差异均无统计学意义（ t =3.00，P =0.09； t =0.94，P =0.09）。移植后90天内，左氧氟沙星+G-CSF组有2例（4.26%）死亡，G-CSF组有1例（1.82%）死亡，两组比较无统计学差异（χ2=0.53，P =0.47）。.
结论: 较G-CSF支持相比，患者在自体造血干细胞移植期间应用G-CSF+左氧氟沙星预防感染无明显获益。.
Keywords: levofloxacin; autologous hematopoietic stem cell transplantation; bacterial infection; febrile neutropenia；antibiotic prophylaxis.