Decreasing the incidence and impact of infections in neutropenic patients: evidence from meta-analyses of randomized controlled trials

ABSTRACT

Backgound: Neutropenia is a common complication of intensive chemotherapy in patients with solid organ or hematologic malignancies that is associated with a high risk for life-threatening infections. Many interventions have been employed in order to limit the incidence of these infections or to treat them when the prophylactic measures fail.

Scope: The commonest characteristic of the randomized controlled trials (RCTs) conducted on this issue was the small sample size. In addition, if RCTs studying the prophylactic interventions were excluded, the aim of most of the rest of relevant RCTs was to prove the equal effectiveness of the tested interventions in terms of treatment success. We searched PubMed and Cochrane database to identify meta-analyses of RCTs in the field of febrile neutropenia.

Results: The most prominent findings of these meta-analyses were the promising effect, although based on open label RCTs, of antimicrobial prophylaxis with fluoroquinolones on the mortality of all neutropenic patients and the beneficial effect of antifungal prophylaxis on mortality of neutropenic patients with allogeneic hematopoetic stem cell transplantation. Another noteworthy finding was the higher mortality associated with empiric cefepime treatment when compared with other β-lactams. In other cases, the findings of the published meta-analyses either confirmed or consolidated the results of individual RCTs.

Conclusion: Meta-analyses are very useful for obtaining a better overview and to provide some general qualitative and quantitative conclusions, but are not always a substitute for appropriately powered, well-designed RCTs. In addition, the reported findings should be interpreted with caution taking into account the limitations of various methodological aspects of meta-analysis in general, as well as the limitations of the individual meta-analyses in this field.

Key words: :

• Antibiotics
• β-lactams
• Fever
• Granulocytopenia
• Prophylaxis