Gafter-Gvili Anat, Fraser Abigail, Paul Mical, Leibovici Leonard
Rabin Medical Center, Petah-Tiqva, Israel.
Ann Intern Med. 2005 Jun 21;142(12 Pt 1):979-95. doi: 10.7326/0003-4819-142-12_part_1-200506210-00008.
Bacterial infections are a major cause of illness and death in patients who are neutropenic after chemotherapy treatment for cancer. Trials have shown the efficacy of antibiotic prophylaxis in decreasing the incidence of bacterial infections but not in reducing mortality rates.
To evaluate whether antibiotic prophylaxis in neutropenic patients reduces mortality and incidence of infection and to assess related adverse events.
The Cochrane Cancer Network register of trials (2004), The Cochrane Library (Issue 4, 2004), EMBASE (1980-2004), MEDLINE (1966-2004), and references of identified studies.
Randomized, controlled trials comparing antibiotic prophylaxis with placebo or no intervention or another antibiotic in afebrile neutropenic patients.
Two reviewers independently appraised the quality of trials and extracted data.
Ninety-five trials performed between 1973 and 2004 met inclusion criteria. Fifty-two trials addressed quinolone prophylaxis. Antibiotic prophylaxis significantly decreased the risk for death when compared with placebo or no treatment (relative risk, 0.67 [95% CI, 0.55 to 0.81]). All prophylactic antibiotics were associated with an increased risk for adverse events (relative risk, 1.69 [CI, 1.14 to 2.50]). Fluoroquinolone prophylaxis reduced the risk for all-cause mortality (relative risk, 0.52 [CI, 0.35 to 0.77]), as well as infection-related mortality, fever, clinically documented infections, and microbiologically documented infections. Fluoroquinolone prophylaxis increased the risk for harboring bacilli resistant to the specific drug after treatment and adverse events, but these results were not statistically significant (relative risks, 1.69 [CI, 0.73 to 3.92]) and 1.30 [CI, 0.61 to 2.76], respectively).
Most trials involved patients with hematologic cancer. Data on all-cause mortality were missing in 10 of 50 trials comparing prophylaxis with no prophylaxis. Effect estimates were larger in trials of unclear methodologic quality compared with trials of adequate methodologic quality.
Antibiotic prophylaxis for neutropenic patients undergoing cytotoxic therapy reduces mortality. Mortality was substantially reduced when analysis was limited to fluoroquinolones. Antibiotic prophylaxis, preferably with a fluoroquinolone, should be considered for neutropenic patients.
细菌感染是癌症化疗后中性粒细胞减少患者发病和死亡的主要原因。试验表明抗生素预防可降低细菌感染的发生率，但不能降低死亡率。
评估中性粒细胞减少患者使用抗生素预防是否能降低死亡率和感染发生率，并评估相关不良事件。
Cochrane癌症试验网络注册库（2004年）、Cochrane图书馆（2004年第4期）、EMBASE（1980 - 2004年）、MEDLINE（1966 - 2004年）以及已识别研究的参考文献。
比较抗生素预防与安慰剂或不干预或另一种抗生素在无发热的中性粒细胞减少患者中的随机对照试验。
两名评价者独立评估试验质量并提取数据。
1973年至2004年进行的95项试验符合纳入标准。52项试验涉及喹诺酮预防。与安慰剂或不治疗相比，抗生素预防显著降低了死亡风险（相对风险，0.67 [95% CI，0.55至0.81]）。所有预防性抗生素都与不良事件风险增加相关（相对风险，1.69 [CI，1.14至2.50]）。氟喹诺酮预防降低了全因死亡率（相对风险，0.52 [CI，0.35至0.77]），以及感染相关死亡率、发热、临床记录的感染和微生物学记录的感染。氟喹诺酮预防增加了治疗后携带对特定药物耐药的杆菌的风险和不良事件风险，但这些结果无统计学意义（相对风险分别为1.69 [CI，0.73至3.92]）和1.30 [CI，0.61至2.76]）。
大多数试验涉及血液系统癌症患者。在50项比较预防与不预防的试验中，有10项试验缺少全因死亡率数据。与方法学质量充分的试验相比，方法学质量不明确的试验中的效应估计值更大。
接受细胞毒性治疗的中性粒细胞减少患者使用抗生素预防可降低死亡率。当分析仅限于氟喹诺酮类药物时，死亡率显著降低。对于中性粒细胞减少患者，应考虑使用抗生素预防，最好是氟喹诺酮类药物。
