Efficacy of fluoroquinolone prophylaxis in high-risk neutropenic patients with haematological malignancies: a systematic review with meta-analysis

Resumo original em inglês

O que aconteceu

To compare the clinical and microbiological outcomes of high-risk neutropenic patients receiving or not fluoroquinolone prophylaxis.

Randomized controlled trials (RCTs) and observational studies investigating overall mortality and rate of febrile episodes, of bloodstream infections and of isolation of a fluoroquinolone-resistant strain among patients receiving or not prophylaxis.

Patients with high-risk neutropenia due to haematological malignancies.

Prophylaxis with either ciprofloxacin or levofloxacin.

No prophylaxis.

We conducted a meta-analysis pooling risk ratios (RRs) through random effect models.

O que encontraram

Among 1731 articles screened, 18 original studies fulfilled the inclusion criteria and were included in the analysis, accounting for a total of 12,586 patients, 7157 (56.9%) of which receiving fluoroquinolones prophylaxis. The analysis assessing the primary outcome including 12,134 patients showed similar mortality rates between groups (RR 1.04, 95% CI 0.79-1.37, p = 0.77), with a low statistical heterogeneity observed (I2 49.4%, p = 0.022). These findings were confirmed (RR 1.16, 95% CI 0.89-1.50, p = 0.27) in the sub-analysis excluding studies conducted in settings with low prevalence of fluoroquinolone resistance, on a total of 3121 patients, and a low heterogeneity was observed (I2 27.6%, p = 0.18). Regarding the incidence of febrile episodes, a lower rate was observed among the 1701 patients receiving prophylaxis as compared to the 1514 not receiving prophylaxis (RR 0.87, 95% CI 0.88-0.96, p = 0.006); similarly, a lower rate of bloodstream infections was demonstrated among subjects receiving fluoroquinolone prophylaxis (RR 0.59, 95% CI 0.47-0.75, p < 0.001) in a meta-analysis including 11,681 patients. Finally, no difference in the isolation rate of fluoroquinolone resistant strains was observed (RR 0.87, 95% CI 0.34-2.20, p = 0.77) among 1481 patients included.

Por que isso importa

Our data suggest that fluoroquinolone prophylaxis in high-risk neutropenic patients is associated with a reduction in the incidence of febrile episodes and bacteraemia but does not provide a survival benefit.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.