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.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-04-29 DOI:10.1111/tid.70049

Hiroshi Ito, Yui Okamura, Yuna Tomura, Jura Oshida, Minori Fujita, Daiki Kobayashi

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引用次数: 0

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 GVHD-related mortality (I² = 63%).

Conclusion: Antibiotics with anaerobic coverage appear to increase acute GVHD incidence in patients who received an allogeneic HSCT compared to antibiotics with limited anaerobic coverage. However, the strength of this conclusion is limited by the quality of available evidence. Further well-designed research is necessary to clarify the impact of anaerobic antibiotic coverage on GVHD-related outcomes.

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无氧覆盖抗生素对异基因造血干细胞移植患者移植物抗宿主病的影响：系统回顾和荟萃分析

背景：广谱抗生素是治疗同种异体造血干细胞移植（HSCT）中发热性中性粒细胞减少症（FN）的标准药物，但可能会破坏肠道微生物群，增加移植物抗宿主病（GVHD）的风险。然而，目前关于厌氧抗生素与有限厌氧抗生素覆盖对gvhd相关结果的影响的证据仍然没有定论。方法：我们系统地检索了在接受无氧和有限无氧覆盖抗生素治疗的同种异体造血干细胞移植患者中评估总生存率、急性GVHD发病率和GVHD相关死亡率的研究。随机效应荟萃分析在评估偏倚风险后计算风险比（rr）和95%置信区间（ci）。结果：323项筛选研究中有6项符合纳入标准，共纳入2169例患者：5项研究纳入成人人群，1项研究纳入儿科人群。荟萃分析显示，无氧组和有限无氧覆盖组的1年总生存率无显著差异(RR: 1.01；95% ci: 0.92-1.12)。无氧覆盖组急性GVHD发生率显著高于有限无氧覆盖组(RR: 1.33；95% ci: 1.17-1.51)。无氧覆盖组gvhd相关死亡率高于有限覆盖组(RR: 1.65；95% ci: 0.94-2.91)。在这6项研究中，有3项存在高偏倚风险。关于gvhd相关死亡率的引用之间存在中度异质性（I2 = 63%）。结论：与无氧覆盖的抗生素相比，无氧覆盖的抗生素似乎增加了接受同种异体造血干细胞移植患者急性GVHD的发病率。然而，这一结论的强度受到现有证据质量的限制。需要进一步精心设计的研究来阐明厌氧抗生素覆盖对gvhd相关结果的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.