Engels E A, Lau J, Barza M
Tupper Research Institute, Department of Medicine, New England Medical Center, Boston, MA 02111, USA.
J Clin Oncol. 1998 Mar;16(3):1179-87. doi: 10.1200/JCO.1998.16.3.1179.
To perform a meta-analysis to estimate the efficacy of quinolone antibiotics in preventing infections, fevers, and deaths among cancer patients neutropenic following chemotherapy.
We searched MEDLINE to identify randomized trials of quinolone prophylaxis, controlled either with no prophylaxis or trimethoprim/sulfamethoxazole (TMS) prophylaxis. We pooled relative risks for outcomes using a random-effects model.
Eighteen trials with 1,408 subjects were included. Compared with no prophylaxis, quinolones significantly reduced the incidence of gram-negative bacterial infections (relative risk, 0.21; 95% confidence interval [CI], 0.12 to 0.37), microbiologically documented infections (0.65; 0.50 to 0.85), total infections (0.54; 0.31 to 0.95), and fevers (0.85; 0.73 to 0.99). Quinolone prophylaxis did not alter the incidence of gram-positive bacterial, fungal, or clinically documented infections, or infection-related deaths. Results were similar for trials that used TMS as the control regimen. Among those who received quinolones, the incidence of infections due to quinolone-resistant organisms was 3.0% (95% CI, 1.7% to 5.2%) for gram-negative species and 9.4% (95% CI, 5.3% to 16.3%) for gram-positive species. Based on limited data, the incidence of quinolone-resistant infections was not higher among quinolone recipients than controls. With fever as outcome, blinded trials found quinolones less efficacious than did unblinded trials.
Quinolone prophylaxis substantially reduces the incidence of various infection-related outcomes, but not deaths, in these patients. Although this reduction in infections may translate into a decrease in morbidity, the reduction in fevers (and by extension, use of empiric antibiotics) appears small, and blinded trials provided less evidence for benefit than unblinded trials. Quinolone-resistant infections are uncommon, but continued vigilance is warranted.
进行一项荟萃分析，以评估喹诺酮类抗生素在预防化疗后中性粒细胞减少的癌症患者感染、发热和死亡方面的疗效。
我们检索了MEDLINE，以确定喹诺酮预防的随机试验，对照为不预防或甲氧苄啶/磺胺甲恶唑（TMS）预防。我们使用随机效应模型汇总结局的相对风险。
纳入了18项试验，共1408名受试者。与不预防相比，喹诺酮类药物显著降低了革兰氏阴性菌感染的发生率（相对风险，0.21；95%置信区间[CI]，0.12至0.37）、微生物学确诊的感染（0.65；0.50至0.85）、总感染（0.54；0.31至0.95）和发热（0.85；0.73至0.99）。喹诺酮预防并未改变革兰氏阳性菌、真菌或临床确诊感染的发生率，也未改变与感染相关的死亡发生率。以TMS作为对照方案的试验结果相似。在接受喹诺酮类药物的患者中，革兰氏阴性菌的喹诺酮耐药菌感染发生率为3.0%（95%CI，1.7%至5.2%），革兰氏阳性菌为9.4%（95%CI，5.3%至16.3%）。基于有限的数据，喹诺酮类药物接受者中喹诺酮耐药感染的发生率并不高于对照组。以发热为结局，盲法试验发现喹诺酮类药物的疗效低于非盲法试验。
喹诺酮预防可显著降低这些患者各种感染相关结局的发生率，但不能降低死亡率。虽然感染率的降低可能会转化为发病率的降低，但发热的降低（以及经验性抗生素的使用）似乎较小，而且盲法试验提供的获益证据少于非盲法试验。喹诺酮耐药感染并不常见，但仍需持续警惕。
