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<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>Despite a significant increase in 30-day Gram-negative BSI incidence post-BATMO (24% vs 15%, <i>P</i> = .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 <i>E. coli</i> strains declined from 100% to 46% (<i>P</i> = .003), and overall Gram-negative resistance dropped from 75% to 36% (<i>P</i> = .006). Use of carbapenems remained unchanged (43% vs 53%, <i>P</i> = .1).<h4>Conclusions</h4>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.

Abstract: PubMed · Datensatz