Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines
Mikulska M, Averbuch D, Tissot F, Cordonnier C, Akova M, Calandra T, Ceppi M, Bruzzi P, Viscoli C (2018)
Publication Type: Journal article
Publication year: 2018
Journal
Book Volume: 76
Pages Range: 20-37
Journal Issue: 1
DOI: 10.1016/j.jinf.2017.10.009
Abstract
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.
Involved external institutions
University of Genova / Università degli Studi di Genova
Italy (IT)
Hadassah Medical Center / מרכז רפואי הדסה
Israel (IL)
Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV)
Switzerland (CH)
Centre hospitalier universitaire Henri-Mondor (CHU Henri-Mondor)
France (FR)
Hacettepe University
Turkey (TR)
Université de Lausanne (UNIL)
Switzerland (CH)
Ospedale San Martino (IRCCS AOU)
Italy (IT)
Italy (IT)
Hadassah Medical Center / מרכז רפואי הדסה
Israel (IL)
Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV)
Switzerland (CH)
Centre hospitalier universitaire Henri-Mondor (CHU Henri-Mondor)
France (FR)
Hacettepe University
Turkey (TR)
Université de Lausanne (UNIL)
Switzerland (CH)
Ospedale San Martino (IRCCS AOU)
Italy (IT)
How to cite
APA:
Mikulska, M., Averbuch, D., Tissot, F., Cordonnier, C., Akova, M., Calandra, T.,... Viscoli, C. (2018). Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines. Journal of Infection, 76(1), 20-37. https://dx.doi.org/10.1016/j.jinf.2017.10.009
MLA:
Mikulska, Malgorzata, et al. "Fluoroquinolone prophylaxis in haematological cancer patients with neutropenia: ECIL critical appraisal of previous guidelines." Journal of Infection 76.1 (2018): 20-37.
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