医学
内科学
菌血症
抗生素
相对风险
左氧氟沙星
科克伦图书馆
造血干细胞移植
预防性抗生素
甲氧苄啶
移植
环丙沙星
中性粒细胞减少症
随机对照试验
置信区间
化疗
微生物学
生物
作者
Grace Egan,Paula D. Robinson,Juan Pablo Díaz Martínez,Sarah Alexander,Roland A. Ammann,L. Lee Dupuis,Brian T. Fisher,Thomas Lehrnbecher,Bob Phillips,Sandra Cabral,George Tomlinson,Lillian Sung
摘要
Abstract Purpose To determine the efficacy and safety of different prophylactic systemic antibiotics in adult and pediatric patients receiving chemotherapy or undergoing hematopoietic stem cell transplantation (HSCT). Methods We conducted a systematic review and performed searches of Ovid MEDLINE, MEDLINE in‐process and Embase; and Cochrane Central Register of Controlled Trials. Studies were included if patients had cancer or were HSCT recipients with anticipated neutropenia, and the intervention was systemic antibacterial prophylaxis. Strategies synthesized included fluoroquinolone vs no antibiotic/nonabsorbable antibiotic; fluoroquinolone vs trimethoprim‐sulfamethoxazole; trimethoprim‐sulfamethoxazole vs no antibiotic; and cephalosporin vs. no antibiotic. Fluoroquinolone vs cephalosporin and levofloxacin vs ciprofloxacin were compared by network meta‐analysis. Primary outcome was bacteremia. Results Of 20 984 citations screened, 113 studies comparing prophylactic antibiotic to control were included. The following were effective in reducing bacteremia: fluoroquinolone vs no antibiotic/nonabsorbable antibiotic (risk ratio (RR) 0.56, 95% confidence interval (CI) 0.41‐0.76), trimethoprim‐sulfamethoxazole vs no antibiotic (RR 0.59, 95% CI 0.41‐0.85) and cephalosporin vs no antibiotic (RR 0.30, 95% CI 0.16‐0.58). Fluoroquinolone was not significantly associated with increased Clostridium difficile infection (RR 0.62, 95% CI 0.31‐1.24) or invasive fungal disease (RR 1.28, 95% CI 0.79‐2.08) but did increase resistance to fluoroquinolone among bacteremia isolates (RR 3.35, 95% CI 1.12 to 10.03). Heterogeneity in fluoroquinolone effect on bacteremia was not explained by evaluated study, population, or methodological factors. Network meta‐analysis revealed no direct comparisons for pre‐specified analyses; superior regimens were not identified. Conclusions Fluoroquinolone, trimethoprim‐sulfamethoxazole, and cephalosporin prophylaxis reduced bacteremia. A clinical practice guideline to facilitate prophylactic antibiotic decision‐making is required.
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