Levofloxacin prophylaxis for pediatric leukemia patients: Longitudinal follow‐up for impact on health care‐associated infections

Background Bloodstream infections (BSIs) cause morbidity and mortality in pediatric patients with leukemia. Antibiotic prophylaxis during periods of chemotherapy‐induced neutropenia may reduce the incidence of BSIs. Procedure 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 years (2 years pre and 2 years post implementation) of the practice guideline to assess the impact on central line‐associated bloodstream infections (CLABSI) and BSI events. Secondary outcomes included incidence of Clostridioides difficile‐associated diarrhea, bacteremia due to multidrug‐resistant organisms (MDRO), and bacteremia due to levofloxacin nonsusceptible organisms. STATA was used for data analysis. Results Sixty‐three and 72 patients met inclusion criteria for the pre‐ and postimplementation cohorts, respectively. Demographics were similar between the groups. We observed 60 BSI events in the pre‐group versus 49 events in the post‐group (p = .1). Bacteremia due to Gram‐negative rods (risk ratio [RR] 0.37 [0.21, 0.66], p