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

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• 作者：Shun-ichi Kimura ; Yu Akahoshi ; Hirofumi Nakano ; Tomotaka Ugai ; Hidenori Wada ; Ryoko Yamasaki ; Yuko Ishihara ; Koji Kawamura ; Kana Sakamoto ; Masahiro Ashizawa ; Miki Sato ; Kiriko Terasako-Saito ; Hideki Nakasone ; Misato Kikuchi ; Rie Yamazaki ; Shinichi Kako ; Junya Kanda ; Aki Tanihara ; Junji Nishida ; Yoshinobu Kanda ; ^{ycanda-tky@umin.ac.jp" class="auth_mail}
• 关键词：Meta-analysis ; Antibiotic prophylaxis ; Hematopoietic stem cell transplantation ; Fluoroquinolones
• 刊名：Journal of Infection
• 出版年：July 2014
• 年：2014
• 卷：69
• 期：1
• 页码：13-25
• 全文大小：2177 K

文摘

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.