Journal article
Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines.
- Mikulska M Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy. Electronic address: m.mikulska@unige.it.
- Averbuch D Pediatric Infectious Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
- Tissot F Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
- Cordonnier C Department of Haematology, Henri Mondor Teaching Hospital, Assistance Publique-hôpitaux de Paris, and Université Paris-Est-Créteil, Créteil, France.
- Akova M Hacettepe University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
- Calandra T Infectious Diseases Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Switzerland.
- Ceppi M Department of Epidemiology, Biostatistics and Clinical Trials Ospedale Policlinico San Martino, Genoa, Italy.
- Bruzzi P Department of Epidemiology, Biostatistics and Clinical Trials Ospedale Policlinico San Martino, Genoa, Italy.
- Viscoli C Division of Infectious Diseases, University of Genoa (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy.
- 2017-10-29
Published in:
- The Journal of infection. - 2018
Ciprofloxacin
Febrile neutropenia
Infection
Levofloxacin
Multidrug resistance (MDR)
Neutropenic
Prevention
Quinolone
Anti-Bacterial Agents
Antibiotic Prophylaxis
Fluoroquinolones
Guidelines as Topic
Hematologic Neoplasms
Humans
Infection Control
Infections
Neutropenia
English
OBJECTIVES
Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated.
METHODS
Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed.
RESULTS
Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains.
CONCLUSIONS
The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.
Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated.
METHODS
Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed.
RESULTS
Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains.
CONCLUSIONS
The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jinf.2017.10.009
- PMID 29079323
- Persistent URL
- https://sonar.ch/global/documents/43450
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