Effect of Quinolone Prophylaxis Discontinuation During Pre-engraftment Neutropenia on Incidence, Mortality, and Etiology of Bloodstream Infections in Hematopoietic Stem-cell Transplant Recipients: A Systematic Review and Meta-analysis
Abstract
Background: Bloodstream infections (BSIs) are a major complication during pre-engraftment neutropenia in hematopoietic stem-cell transplant (HSCT) recipients. Quinolone prophylaxis reduces BSIs but increases multidrug-resistance bacterial infections. We aimed to assess the impact of discontinuing quinolone prophylaxis in adult HSCT recipients.
Methods: We performed a systematic review with meta-analysis. Five databases were searched on May 20, 2025. Studies were eligible for inclusion if they reported clinical characteristics of adult HSCT recipients and outcomes following the discontinuation of prophylaxis. Data extraction and quality assessment were performed independently by 2 reviewers. Meta-analysis was performed and pooled risk ratios with 95% CI calculated using a random-effects model.
Results: Ten studies including 2363 HSCT recipients (1190 with and 1173 without prophylaxis) were included. Most were allogeneic-HSCT (53.1%). Prophylaxis was associated with a lower risk of BSIs due to any microorganism (pooled risk ratio: 0.69; 95% CI 0.54-0.87; P value = .002; I2 = 61%) and due to Gram-negative bacteria (pooled risk ratio: 0.49; 95% CI 0.33-0.74; P value = .0007; I2 = 71%). In the overall population, there was no significant difference in resistant infections. In patients with Gram-negative BSIs, prophylaxis was associated with a higher risk of quinolone-resistant (pooled risk ratio: 2.35; 95% CI 1.68-3.29; P value 2 = 27%) and carbapenem-resistant microorganisms…
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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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