Infection-control interventions for cancer patients after chemotherapy: a systematic review and meta-analysis

Lancet Infect Dis. 2009 Feb;9(2):97-107. doi: 10.1016/S1473-3099(08)70284-6. Epub 2008 Dec 16.

Abstract

To quantify the evidence for infection-control interventions among high-risk cancer patients and haematopoietic stem-cell recipients, we did a systematic review of prospective comparative studies. Protective isolation, including air quality control, prophylactic antibiotics, and barrier isolation (29 studies), brought about a significant reduction in all-cause mortality: risk ratio 0.60 (95% CI 0.50-0.72) at 30 days (number needed to treat [NNT] 20 [95% CI 14-33]) and 0.86 (95% CI 0.81-0.91) at the longest follow-up (up to 3 years; NNT 12 [95% CI 9-20]). Inclusion of prophylactic antibiotics in the intervention was necessary to show the effect on mortality. The combined intervention reduced bacteraemia, and Gram-negative, Gram-positive, and Candida spp infections. Mould infections were not significantly reduced. 11 non-randomised prospective studies assessed inpatient versus outpatient management after autologous stem-cell transplantation. All-cause mortality was lower among outpatients: risk ratio 0.72 [95% CI 0.55-0.95]. We conclude that prophylactic antibiotics are the most effective treatment within the protective environment. Randomised trials on outpatient management of haematological cancer patients are needed.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anti-Infective Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bacterial Infections / microbiology
  • Bacterial Infections / mortality
  • Bacterial Infections / prevention & control
  • Clinical Trials as Topic
  • Cross Infection / prevention & control*
  • Humans
  • Infection Control / methods*
  • Mycoses / microbiology
  • Mycoses / prevention & control
  • Neoplasms / drug therapy*
  • Treatment Outcome

Substances

  • Anti-Infective Agents