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Tytuł pozycji:

Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review

Tytuł :
Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review
Autorzy :
Märtson, Anne-Grete
Alffenaar, Jan-Willem C
Bakker, Martijn
Blokzijl, Hans
Verschuuren, Erik A M
Berger, Stefan P
Span, Lambert F R
van der Werf, Tjip S
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Temat :
infectious diseases
transplant medicine
infection control
Źródło :
BMJ Open, 10(1). BMJ PUBLISHING GROUP
Wydawca :
BMJ Publishing Group, 2020.
Rok publikacji :
2020
Kolekcja :
NARCIS
Oryginalny identyfikator :
pmc: PMC6955515
pmid: 31915177
Opis pliku :
application/pdf
Język :
English
ISSN :
2044-6055
DOI :
10.1136/bmjopen-2019-034940
OBJECTIVES: Infections remain a threat for solid organ and stem cell transplant recipients. Antimicrobial prophylaxis and pre-emptive therapy have improved survival of these patients; however, the failure rates of prophylaxis are not negligible. The aim of this systematic review is to explore the reasons behind failure of antimicrobial prophylaxis and pre-emptive therapy. SETTING: This systematic review included prospective randomised controlled trials and prospective single-arm studies. PARTICIPANTS: The studies included were on prophylaxis and pre-emptive therapy of opportunistic infections in transplant recipients. Studies were included from databases MEDLINE, CENTRAL and Embase published until October first 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures were breakthrough infections, adverse events leading to stopping of treatment, switching medication or dose reduction. Secondary outcome measures were acquired resistance to antimicrobials, antifungals or antivirals and death. RESULTS: From 3317 identified records, 30 records from 24 studies with 2851 patients were included in the systematic review. Seventeen focused on prophylactic and pre-emptive treatment of cytomegalovirus and seven studies on invasive fungal infection. The main reasons for failure of prophylaxis and pre-emptive therapy were adverse events and breakthrough infections, which were described in 54% (13 studies) and 38% (9 studies) of the included studies, respectively. In 25%, six of the studies, a detailed description of patients who experienced failure of prophylaxis or pre-emptive therapy was unclear or lacking. CONCLUSIONS: Our results show that although failure is reported in the studies, the level of detail prohibits a detailed analysis of failure of prophylaxis and pre-emptive therapy. Clearly reporting on patients with a negative outcome should be improved. We have provided guidance on how to detect failure early in a clinical setting in accordance to the results from this systematic review. PROSPERO REGISTRATION NUMBER: CRD42017077606.

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