title: Antibiotic prophylaxis in hematopoietic stem cell transplantation. A meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  We performed a meta-analysis to evaluate the impact of systemic antibiotic prophylaxis in hematopoietic stem cell transplantation (HSCT) recipients.
  
  
  METHODS
  We collected reports from PubMed, the Cochrane Library, EMBASE, CINAHL, and Web of Science, along with references cited therein. We included prospective, randomized studies on systemic antibiotic prophylaxis in HSCT recipients.
  
  
  RESULTS
  Seventeen trials with 1453 autologous and allogeneic HSCT recipients were included. Systemic antibiotic prophylaxis was compared with placebo or no prophylaxis in 10 trials and with non-absorbable antibiotics in two trials. Systemic antibiotics other than fluoroquinolones were evaluated in five of these 12 trials. Four trials evaluated the effect of the addition of antibiotics for gram-positive bacteria to fluoroquinolones. One trial compared two different systemic antibiotic regimens: fluoroquinolones versus trimethoprim-sulfamethoxazole. As a result, systemic antibiotic prophylaxis reduced the incidence of febrile episodes (OR 0.16; 95%CI 0.09-0.30), clinically or microbiologically documented infection (OR 0.38; 95%CI 0.22-0.63) and bacteremia (OR 0.31; 95%CI 0.16-0.59) without significantly affecting all-cause mortality or infection-related mortality.
  
  
  CONCLUSIONS
  Systemic antibiotic prophylaxis successfully reduced the incidence of infection. However, there was no significant impact on mortality. The clinical benefits of prophylaxis with fluoroquinolones were inconclusive because of the small number of clinical trials evaluated.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Shun-ichi
authors.initials: S
authors.lastname: Kimura
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Akahoshi
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakano
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ugai
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Wada
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ishihara
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawamura
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Sakamoto
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ashizawa
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Sato
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Kiriko
authors.initials: K
authors.lastname: Terasako-Saito
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Kikuchi
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yamazaki
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Tanihara
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Nishida
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan. Electronic address: ycanda-tky@umin.ac.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D001424:Bacterial Infections / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic prophylaxis; Fluoroquinolones; Hematopoietic stem cell transplantation; Meta-analysis