Ishikawa Kazuhiro, Masaki Tetsuhiro, Kawai Fujimi, Ota Erika, Mori Nobuyoshi
Department of Infectious Diseases, St. Luke's International Hospital, Tokyo 104-8560, Japan.
Library, Center for Academic Resources, St. Luke's International University, Tokyo 104-0044, Japan.
Cancers (Basel). 2023 Mar 5;15(5):1611. doi: 10.3390/cancers15051611.
Early antibiotic discontinuation has been proposed in patients with hematologic malignancy with fever of unknown origin during febrile neutropenia (FN). We intended to investigate the safety of early antibiotic discontinuation in FN. Two reviewers independently searched for articles from Embase, CENTRAL, and MEDLINE on 30 September 2022. The selection criteria were randomized control trials (RCTs) comparing short- and long-term durations for FN in cancer patients, and evaluating mortality, clinical failure, and bacteremia. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. We identified eleven RCTs (comprising 1128 distinct patients with FN) from 1977 to 2022. A low certainty of evidence was observed, and no significant differences in mortality (RR 1.43, 95% CI, 0.81, 2.53, I = 0), clinical failure (RR 1.14, 95% CI, 0.86, 1.49, I = 25), or bacteremia (RR 1.32, 95% CI, 0.87, 2.01, I = 34) were identified, indicating that the efficacy of short-term treatment may not differ statistically from that of long-term treatment. Regarding patients with FN, our findings provide weak conclusions regarding the safety and efficacy of antimicrobial discontinuation prior to neutropenia resolution.
对于血液系统恶性肿瘤且在发热性中性粒细胞减少（FN）期间出现不明原因发热的患者，有人提出应尽早停用抗生素。我们旨在研究在FN患者中尽早停用抗生素的安全性。2022年9月30日，两名评审员独立在Embase、CENTRAL和MEDLINE上检索文章。选择标准为比较癌症患者FN短期和长期疗程，并评估死亡率、临床治疗失败率和菌血症的随机对照试验（RCT）。计算了具有95%置信区间（CI）的风险比（RR）。我们从1977年至2022年共识别出11项RCT（包含1128例不同的FN患者）。观察到证据的确定性较低，未发现死亡率（RR 1.43，95% CI，0.81，2.53，I² = 0）、临床治疗失败率（RR 1.14，95% CI，0.86，1.49，I² = 25）或菌血症（RR 1.32，95% CI，0.87，2.01，I² = 34）存在显著差异，这表明短期治疗的疗效在统计学上可能与长期治疗无差异。对于FN患者，我们的研究结果对于在中性粒细胞减少症缓解之前停用抗菌药物的安全性和疗效得出了不太有力的结论。
