Efficacy of Oral Ciprofloxacin Prophylaxis in BMT Recipients: A Case-Control Study.
Notice bibliographique
Résumé
Abstract Bacterial infections remain a major source for morbidity and mortality in peripheral stem cell (PSC) and bone marrow (BM) transplant recipients. Despite the considerable number clinical trials, there is still no consensus of opinions for the use of antibiotic prophylaxis. In order to analyze the impact on bacteraemia of withdrawing ciprofloxacin prophylaxis from PSC and BM transplant patients during neutropenia, a total of 617 records were reviewed and found suitable for analysis; 310 autologous and 307 allogenic from Jan 4, 2001 to Dec 27, 2005. Ciprofloxacin was used as a prophylactic measure among all these autologous and allogenic stem cell and bone marrow transplant patients until January 31, 2004. As of February 1, 2004, it was no longer given as a prophylactic measure. Patient characteristics were found similar in the group with ciprofloxacin prophylaxis and the group without ciprofloxacin prophylaxis. Resistant bacteraemia was defined as either ciprofloxacin resistant gram negative bacteria, or VRE, or MRSA. For the analysis the two proportions were compared with a log binomial regression model using generalized estimating equations to account for the lack of independence in the observations. Bacteraemia was the dependent variable, and time periods prior transplant year and year of transplant were included as independent variables. The model was used to generate variance estimates for the proportions, and to check for confounding. Prior transplant year or year of transplant were not confounding variables so, there was no need for adjusted estimates. The analysis shows that the relative risk of developing bacteraemia in the autologous and allogenic groups after ciprofloxacin prophylaxis was discontinued compared with when it was used routinely in the same group was 0.6 (95% CI: 0.2–1.6) and 0.8 (95% CI: 0.4–1.6) respectively. The change in the proportion of patients developing bacteraemia was not statistically significant .The estimation of 100 day-survival from transplant was determined by time period using the Kaplan-Meier Method. The analysis was limited to patients who did not have a prior transplant. In the autologous group, no difference was found when ciprofloxacin prophylaxis was used routinely (n=155): 93.6 (95% CI: 88.3–96.5) versus ciprofloxacin prophylaxis not used (n=112): 94.1 (95% CI: 88.1–97.2). Likewise, no difference was found in the allogenic group when ciprofloxacin prophylaxis used routinely (n=135): 88.9 (95% CI: 82.3–93.2) versus Ciprofloxacin prophylaxis not used (n=106): 87.7 (95% CI: 79.8–92.7). The incidence of bacteraemia with resistant organisms was not statistically significant in both groups. In the autologous groups the incidence was 2 (18.2%) with ciprofloxacin prophylaxis and 1 (20.0%) without ciprofloxacin prophylaxis. In the allogenic group the incidence was 5 (2.8%) with ciprofloxacin prophylaxis and 3 (2.3%) without ciprofloxacin prophylaxis . Overall, in our institution, stopping ciprofloxacin prophylaxis did not significantly affect the incidence of bacteraemia, the 100 days all-cause mortality or the incidence of antibiotic resistant bacteraemia among allogenic and autologous transplant patients. As a result, ciprofloxacin prophylaxis has been suspended and a surveillance program has been adopted.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».