Gafter-Gvili Anat, Paul Mical, Fraser Abigail, Leibovici Leonard
Department of Medicine E, Beilinson Campus, Rabin Medical Center, Petah-Tiqva, Israel.
J Antimicrob Chemother. 2007 Jan;59(1):5-22. doi: 10.1093/jac/dkl425. Epub 2006 Oct 30.
To assess the effect of quinolone prophylaxis following chemotherapy for malignancies on the emergence of resistant bacteria in neutropenic patients.
Systematic review and meta-analysis of randomized controlled trials comparing quinolone prophylaxis with placebo or no intervention, or another antibiotic, for the prevention of bacterial infections in afebrile neutropenic patients. The Cochrane Library, PubMed, Embase, conference proceedings and references were searched. Two reviewers independently applied selection criteria, carried out quality assessment and extracted the data. Relative risks (RR) with 95% confidence intervals (CIs) were estimated and pooled. Primary outcomes were rates of colonization and infection by quinolone-resistant bacteria.
The search yielded 56 trials, 22 compared quinolones with placebo or no intervention. Data on colonization by resistant organisms could be extracted from 27 trials (48%). When compared with placebo or no intervention, there was a statistically non-significant increase in colonization with organisms resistant to quinolones (RR 1.68; 95% CI 0.71-4.00). There was no difference in the number of patients developing infections caused by resistant pathogens (RR 1.04; 95% CI 0.73-1.50). In trials comparing quinolones with trimethoprim/sulfamethoxazole, there were fewer incidents of colonization by bacteria resistant to the prophylactic agent in the quinolone arm than in the trimethoprim/sulfamethoxazole arm (RR 0.49; 95% CI 0.37-0.66). Data on baseline resistance of colonizing isolates, resistance development and cross-resistance to beta-lactam antibiotics were too scarce to analyse.
Patients treated with quinolones have a non-significant increase in colonization by quinolone-resistant bacteria. There is no difference in the number of infections caused by pathogens resistant to quinolones. As quinolone prophylaxis reduces the risk of death in neutropenic patients, the risk associated with colonization and infections caused by quinolone-resistant organisms does not outweigh the gain. Future trials should focus on better documentation of infections caused by resistant organisms.
评估恶性肿瘤化疗后使用喹诺酮类药物预防对中性粒细胞减少患者耐药菌出现的影响。
对随机对照试验进行系统评价和荟萃分析，比较喹诺酮类药物预防与安慰剂或不干预，或另一种抗生素，用于预防无发热中性粒细胞减少患者的细菌感染。检索了Cochrane图书馆、PubMed、Embase、会议论文集和参考文献。两名评价者独立应用选择标准、进行质量评估并提取数据。估计并汇总了具有95%置信区间（CI）的相对风险（RR）。主要结局是喹诺酮耐药菌的定植率和感染率。
检索得到56项试验，其中22项比较了喹诺酮类药物与安慰剂或不干预。可从27项试验（48%）中提取耐药菌定植的数据。与安慰剂或不干预相比，喹诺酮耐药菌的定植有统计学上无显著意义的增加（RR 1.68；95%CI 0.71 - 4.00）。由耐药病原体引起感染的患者数量没有差异（RR 1.04；95%CI 0.73 - 1.50）。在比较喹诺酮类药物与甲氧苄啶/磺胺甲恶唑的试验中，喹诺酮组中对预防药物耐药的细菌定植事件少于甲氧苄啶/磺胺甲恶唑组（RR 0.49；95%CI 0.37 - 0.66）。关于定植分离株的基线耐药性、耐药性发展以及对β-内酰胺类抗生素的交叉耐药性的数据过于稀少，无法进行分析。
接受喹诺酮类药物治疗的患者中，喹诺酮耐药菌的定植有不显著的增加。由喹诺酮耐药病原体引起的感染数量没有差异。由于喹诺酮类药物预防可降低中性粒细胞减少患者的死亡风险，与喹诺酮耐药菌定植和感染相关的风险并不超过获益。未来的试验应侧重于更好地记录由耐药菌引起的感染情况。
