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Review
. 2022 Nov 3;9(12):ofac594.
doi: 10.1093/ofid/ofac594. eCollection 2022 Dec.

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

Davide Leardini  1 , Edoardo Muratore  1 , Nicoletta Abram  1 , Francesco Baccelli  1 , Tamara Belotti  1 , Arcangelo Prete  1 , Davide Gori  2 , Riccardo Masetti  1   3
Affiliations
Review

Effectiveness of Quinolone Prophylaxis in Pediatric Acute Leukemia and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-analysis

Davide Leardini et al. Open Forum Infect Dis. .

Abstract

The effectiveness of quinolone prophylaxis in high-risk hematological pediatric patients is controversial. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including studies that involved children and young adults undergoing chemotherapy for acute leukemia or hematopoietic stem cell transplantation (HSCT) who received quinolone prophylaxis compared with no prophylaxis. A meta-analysis was performed on bloodstream infections and neutropenic fever. Data regarding the impact of prophylaxis on overall survival, antibiotic exposure, antibiotic-related adverse effects, antibiotic resistance, Clostridium difficile infections, fungal infections, length of hospitalization, and costs were reviewed in the descriptive analysis. Sixteen studies were included in the qualitative analysis, and 10 of them met the criteria for quantitative analysis. Quinolone prophylaxis was effective in reducing the rate of bloodstream infections and neutropenic fever in pediatric acute leukemia compared with no prophylaxis, but it had no significant effect in HSCT recipients. Prophylaxis was associated with a higher rate of bacterial resistance to fluoroquinolones and higher antibiotic exposure.

Keywords: acute leukemia; meta-analysis; pediatric; quinolone prophylaxis; stem cell transplantation.

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Figures

Figure 1.
Figure 1.
PRISMA flow diagram of the search strategy and included studies. The relevant number of papers at each point is given. Abbreviation: BSI, bloodstream infection; NF, neutropenic fever; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Forest plot showing the association between the use of quinolone PPX and the incidence of BSI in pediatric patients with AL or receiving HSCT. Abbreviations: AB, antibiotics; AL, acute leukemia; BSI, bloodstream infection; HSCT, hematopoietic stem cell transplantation; PPX, prophylaxis.
Figure 3.
Figure 3.
Forest plot showing the association between the use of quinolone PPX and the incidence of BSI in pediatric patients with AL. Abbreviations: AB, antibiotics; AL, acute leukemia; BSI, bloodstream infection; PPX, prophylaxis.
Figure 4.
Figure 4.
Forest plot showing the association between the use of quinolone PPX and the incidence of BSI in pediatric patients with HSCT. Abbreviations: AB, antibiotics; BSI, bloodstream infection; HSCT, hematopoietic stem cell transplantation; PPX, prophylaxis.
Figure 5.
Figure 5.
Forest plot showing the association between the use of quinolone PPX and the incidence of NF in pediatric patients with AL and HSCT. Abbreviations: AB, antibiotics; AL, acute leukemia; HSCT, hematopoietic stem cell transplantation; NF, neutropenic fever; PPX, prophylaxis.
Figure 6.
Figure 6.
Forest plot showing the association between the use of quinolone PPX and the incidence of NF in pediatric patients with AL. Abbreviations: AB, antibiotics; AL, acute leukemia; NF, neutropenic fever; PPX, prophylaxis.
See this image and copyright information in PMC

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