Evidence map›Paper›PMID 31915177›Full record

SynthesisBMJ open2020

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

Anne-Grete Märtson, Martijn Bakker, Hans Blokzijl, Erik A M Verschuuren, Stefan P Berger, Lambert F R Span, Tjip S van der Werf, Jan-Willem C Alffenaar

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Anne-Grete MärtsonDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.ORCID 0000-0001-6478-1959
Martijn BakkerDepartment of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Hans BlokzijlDepartment of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Erik A M VerschuurenDepartment of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Stefan P BergerDepartment of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Lambert F R SpanDepartment of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Tjip S van der WerfDepartment of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Jan-Willem C AlffenaarDepartment of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands j.w.c.alffenaar@umcg.nl.ORCID 0000-0001-6703-0288

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesInfections 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.

settingThis systematic review included prospective randomised controlled trials and prospective single-arm studies.

participantsThe 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.

resultsFrom 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.

conclusionsOur 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.

Indexed as

Antibiotic ProphylaxisAdultClinical Trials as TopicCytomegalovirus InfectionsDocumentationDrug Resistance, MicrobialHumansInvasive Fungal InfectionsOpportunistic InfectionsOrgan TransplantationRandomized Controlled Trials as TopicStem Cell TransplantationTransplant RecipientsTreatment Failureinfection controlinfectious diseasestransplant medicine

Identifiers

PMID31915177
PMCPMC6955515

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.