Antibiotic prophylaxis in hematopoietic stem cell transplantation. A meta-analysis of randomized controlled trials

Summary Objectives We performed a meta-analysis to evaluate the impact of systemic antibiotic prophylaxis in hematopoietic stem cell transplantation (HSCT) recipients. Methods We collected reports from PubMed, the Cochrane Library, EMBASE, CINAHL, and Web of Science, along with references cited ther...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of infection 2014-07, Vol.69 (1), p.13-25
Main Authors: Kimura, Shun-ichi, Akahoshi, Yu, Nakano, Hirofumi, Ugai, Tomotaka, Wada, Hidenori, Yamasaki, Ryoko, Ishihara, Yuko, Kawamura, Koji, Sakamoto, Kana, Ashizawa, Masahiro, Sato, Miki, Terasako-Saito, Kiriko, Nakasone, Hideki, Kikuchi, Misato, Yamazaki, Rie, Kako, Shinichi, Kanda, Junya, Tanihara, Aki, Nishida, Junji, Kanda, Yoshinobu
Format: Article
Language:English
Subjects:
Administration, Intravenous
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anti-Bacterial Agents - administration & dosage
Antibacterial agents
Antibiotic prophylaxis
Antibiotic Prophylaxis - methods
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacterial Infections - prevention & control
Biological and medical sciences
Bone marrow, stem cells transplantation. Graft versus host reaction
Fluoroquinolones
General aspects
Hematopoietic stem cell transplantation
Hematopoietic Stem Cell Transplantation - adverse effects
Humans
Immunocompromised Host
Incidence
Infectious Disease
Medical sciences
Meta-analysis
Pharmacology. Drug treatments
Randomized Controlled Trials as Topic
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Objectives We performed a meta-analysis to evaluate the impact of systemic antibiotic prophylaxis in hematopoietic stem cell transplantation (HSCT) recipients. Methods We collected reports from PubMed, the Cochrane Library, EMBASE, CINAHL, and Web of Science, along with references cited therein. We included prospective, randomized studies on systemic antibiotic prophylaxis in HSCT recipients. Results Seventeen trials with 1453 autologous and allogeneic HSCT recipients were included. Systemic antibiotic prophylaxis was compared with placebo or no prophylaxis in 10 trials and with non-absorbable antibiotics in two trials. Systemic antibiotics other than fluoroquinolones were evaluated in five of these 12 trials. Four trials evaluated the effect of the addition of antibiotics for gram-positive bacteria to fluoroquinolones. One trial compared two different systemic antibiotic regimens: fluoroquinolones versus trimethoprim-sulfamethoxazole. As a result, systemic antibiotic prophylaxis reduced the incidence of febrile episodes (OR 0.16; 95%CI 0.09–0.30), clinically or microbiologically documented infection (OR 0.38; 95%CI 0.22–0.63) and bacteremia (OR 0.31; 95%CI 0.16–0.59) without significantly affecting all-cause mortality or infection-related mortality. Conclusions Systemic antibiotic prophylaxis successfully reduced the incidence of infection. However, there was no significant impact on mortality. The clinical benefits of prophylaxis with fluoroquinolones were inconclusive because of the small number of clinical trials evaluated.
ISSN:0163-4453
1532-2742
DOI:10.1016/j.jinf.2014.02.013