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Abstract

Background. Polyoma BK virus (BKV) is associated with hemorrhagic cystitis during hematopoietic stem cell transplantation (HSCT). The objective of this study was to test whether standard-dose ciprofloxacin might suppress reactivation of BKV infection during HSCT.

Methods. Sixty-eight patients received ciprofloxacin or a cephalosporin as antibiotic prophylaxis after undergoing allogeneic HSCT. Urine samples were collected weekly from day 7 before HSCT to day 50 after HSCT. Laboratory investigations included quantification of BKV load and urinary ciprofloxacin levels and in vitro drug sensitivity of BKV.

Results. Twenty-two patients received ciprofloxacin, 21 received cephalosporins, 12 received concomitant corticosteroids and antibiotics (9 received ciprofloxacin, and 3 received cephalosporins), and 13 received interrupted ciprofloxacin therapy. Ciprofloxacin recipients developed a significantly lower peak BKV load, compared with cephalosporin recipients (median, 3 × 105 copies/mL vs. 2.6 × 109 copies/mL; P = .021), irrespective of concomitant receipt of corticosteroid therapy. Fewer ciprofloxacin recipients than cephalosporin recipients (P = .013) developed BKV viruria with a ⩾3-log increase in BKV load during HSCT, which was associated with significantly more cases of hemorrhagic cystitis (8 of 29 patients with a peak increase of ⩾3 log vs. 0 of 39 patients without a peak increase of this level; P < .001). Ciprofloxacin recipients excreted ciprofloxacin in urine at a mean 24-h rate of 71.7 µg/mL (range, 23.0–152.9 µg/mL), which was comparable with the in vitro inhibitory concentration of 125–250 µg/mL of ciprofloxacin found for 3 of 7 BKV isolates.

Conclusions. Ciprofloxacin decreased urinary BKV reactivation after HSCT.

© 2005 by the Infectious Diseases Society of America
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