急性白血病患儿诱导化疗期间抗生素预防的比较有效性和安全性：一项系统评价和荟萃分析。
Comparative effectiveness and safety of antibiotic prophylaxis during induction chemotherapy in children with acute leukaemia: a systematic review and meta-analysis.
作者信息
Yang M, Lu X, Xin L, Luo J, Diao S, Jia Z, Cheng G, Zeng L, Zhang L
机构信息
Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China; Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China; NMPA Key Laboratory for Technical Research on Drug Products In Vitro and In Vivo Correlation, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China; Department of Paediatric Haematology and Oncology, West China Second Hospital, Sichuan University, Chengdu, China.
出版信息
J Hosp Infect. 2023 Jun;136:20-29. doi: 10.1016/j.jhin.2023.03.003. Epub 2023 Mar 13.
BACKGROUND
Bacterial infections are common during induction therapy in children and adolescents with acute leukaemia and may cause infection-related mortality.
AIM
To determine the efficacy and safety of prophylactic antibiotics in paediatric patients with acute leukaemia receiving induction chemotherapy.
METHODS
From three English databases and four Chinese databases, we searched for randomized controlled trials (RCTs) and cohort studies that compared prophylactic antibiotics to placebo, no prophylaxis, or that compared one antibiotic versus another in paediatric patients with acute leukaemia undergoing induction chemotherapy. Two reviewers independently screened the studies, extracted data, and assessed the risk of bias using Cochrane Risk of Bias 2 tool and Newcastle-Ottawa Scale, and the certainty of evidence using Grading of Recommendations Assessment, Development, and Evaluation (GRADE).
FINDINGS
Two RCTs and ten cohort studies were finally included. For children with acute lymphoblastic leukaemia, antibiotic prophylaxis, including levofloxacin, sulfamethoxazole-trimethoprim, or other antibiotics, probably reduced bacteraemia (risk ratio (RR): 0.44; 95% confidence interval (CI): 0.33-0.60; moderate certainty) without significantly increasing Clostridioides difficile infection (CDI) or invasive fungal infection. Levofloxacin reduced the CDI rate (RR: 0.08; 95% CI: 0.01-0.62; high certainty). Ciprofloxacin prophylaxis probably reduced infection-related mortality (RR: 0.12; 95% CI: 0.01-0.97; moderate certainty). In children with acute myeloid leukaemia, ciprofloxacin plus vancomycin may reduce febrile neutropenia (RR: 0.79; 95% CI: 0.66-0.94; low certainty). Individual studies indicated that prophylaxis increased antibiotic exposure but reduced non-preventive antibiotic exposure.
CONCLUSION
In children with acute leukaemia undergoing induction therapy, antibiotic prophylaxis may improve the bacterial infection and mortality.
背景
在急性白血病儿童和青少年的诱导治疗期间，细菌感染很常见，并且可能导致与感染相关的死亡。
目的
确定预防性使用抗生素对接受诱导化疗的儿科急性白血病患者的疗效和安全性。
方法
我们从三个英文数据库和四个中文数据库中检索了随机对照试验（RCT）和队列研究，这些研究比较了预防性使用抗生素与安慰剂、不进行预防，或比较了在接受诱导化疗的儿科急性白血病患者中一种抗生素与另一种抗生素的效果。两名评价员独立筛选研究、提取数据，并使用Cochrane偏倚风险2工具和纽卡斯尔-渥太华量表评估偏倚风险，以及使用推荐分级的评估、制定和评价（GRADE）来评估证据的确定性。
结果
最终纳入了两项RCT和十项队列研究。对于急性淋巴细胞白血病儿童，抗生素预防，包括左氧氟沙星、复方磺胺甲恶唑或其他抗生素，可能降低菌血症（风险比（RR）：0.44；95%置信区间（CI）：0.33 - 0.60；中等确定性），且不会显著增加艰难梭菌感染（CDI）或侵袭性真菌感染。左氧氟沙星降低了CDI发生率（RR：0.08；95%CI：0.01 - 0.62；高确定性）。环丙沙星预防可能降低与感染相关的死亡率（RR：0.12；95%CI：0.01 - 0.97；中等确定性）。对于急性髓细胞白血病儿童，环丙沙星加万古霉素可能降低发热性中性粒细胞减少症的发生率（RR：0.79；95%CI：0.66 - 0.94；低确定性）。个别研究表明，预防增加了抗生素暴露，但减少了非预防性抗生素暴露。
结论
在接受诱导治疗的急性白血病儿童中，抗生素预防可能改善细菌感染情况并降低死亡率。
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