Antibiotic prophylaxis in hematopoietic stem cell transplantation: A meta-analysis ofrandomized controlled trials

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

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)13-25
Number of pages13
JournalJournal of Infection
Volume69
Issue number1
DOIs
Publication statusPublished - 2014 Jan 1
Externally publishedYes

Fingerprint

Antibiotic Prophylaxis
Hematopoietic Stem Cell Transplantation
Fluoroquinolones
Meta-Analysis
Anti-Bacterial Agents
Mortality
Infection
Incidence
Sulfamethoxazole Drug Combination Trimethoprim
Gram-Positive Bacteria
Bacteremia
PubMed
Libraries
Fever
Placebos
Clinical Trials
Prospective Studies

Keywords

  • Antibiotic prophylaxis
  • Fluoroquinolones
  • Hematopoietic stem cell transplantation
  • Meta-analysis

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases
  • Medicine(all)

Cite this

Antibiotic prophylaxis in hematopoietic stem cell transplantation : A meta-analysis ofrandomized controlled trials. / 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.

In: Journal of Infection, Vol. 69, No. 1, 01.01.2014, p. 13-25.

Research output: Contribution to journalReview article

Kimura, SI, Akahoshi, Y, Nakano, H, Ugai, T, Wada, H, Yamasaki, R, Ishihara, Y, Kawamura, K, Sakamoto, K, Ashizawa, M, Sato, M, Terasako-Saito, K, Nakasone, H, Kikuchi, M, Yamazaki, R, Kako, S, Kanda, J, Tanihara, A, Nishida, J & Kanda, Y 2014, 'Antibiotic prophylaxis in hematopoietic stem cell transplantation: A meta-analysis ofrandomized controlled trials', Journal of Infection, vol. 69, no. 1, pp. 13-25. https://doi.org/10.1016/j.jinf.2014.02.013
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. / Antibiotic prophylaxis in hematopoietic stem cell transplantation : A meta-analysis ofrandomized controlled trials. In: Journal of Infection. 2014 ; Vol. 69, No. 1. pp. 13-25.
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abstract = "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.",
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AU - Kimura, Shun ichi

AU - Akahoshi, Yu

AU - Nakano, Hirofumi

AU - Ugai, Tomotaka

AU - Wada, Hidenori

AU - Yamasaki, Ryoko

AU - Ishihara, Yuko

AU - Kawamura, Koji

AU - Sakamoto, Kana

AU - Ashizawa, Masahiro

AU - Sato, Miki

AU - Terasako-Saito, Kiriko

AU - Nakasone, Hideki

AU - Kikuchi, Misato

AU - Yamazaki, Rie

AU - Kako, Shinichi

AU - Kanda, Junya

AU - Tanihara, Aki

AU - Nishida, Junji

AU - Kanda, Yoshinobu

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

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KW - Fluoroquinolones

KW - Hematopoietic stem cell transplantation

KW - Meta-analysis

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