Effect of Antibiotics With Anaerobic Coverage on Graft-Versus-Host Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis
Abstract
ABSTRACT Background Broad‐spectrum antibiotics are standard for febrile neutropenia (FN) in allogeneic hematopoietic stem cell transplantation (HSCT) but may disrupt gut microbiota, increasing the risk of graft‐versus‐host disease (GVHD). However, current evidence on the effects of anaerobic versus limited anaerobic antibiotic coverage on GVHD‐related outcomes remains inconclusive. Methods We systematically searched for studies assessing overall survival, acute GVHD incidence, and GVHD‐related mortality in patients with allogeneic HSCT receiving antibiotics with anaerobic versus limited anaerobic coverage. A random‐effects meta‐analysis calculated risk ratios (RRs) and 95% confidence intervals (CIs) after assessing bias risk. Results Six of the 323 screened studies met the inclusion criteria, encompassing 2169 patients: five studies included adult populations, and one included a pediatric population. Meta‐analysis revealed no significant difference in 1‐year overall survival between the anaerobic and the limited anaerobic coverage groups (RR: 1.01; 95% CI: 0.92–1.12). Acute GVHD incidence was significantly higher in the anaerobic coverage group than in the limited anaerobic coverage group (RR: 1.33; 95% CI: 1.17–1.51). GVHD‐related mortality tended to be higher in the anaerobic coverage group than in the limited coverage group (RR: 1.65; 95% CI: 0.94–2.91). Of the six studies, three had a high risk of bias. Moderate heterogeneity was observed between citations regarding…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,169 participants or records.
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