NEW YORK -- December 19, 2008 -- A combination of prophylactic antibiotics, barrier isolation, and air quality control measures substantially reduces the risk of death in high-risk cancer patients who are immunocompromised due to chemotherapy or stem cell transplantation, according to a study published early online and appearing in the February 2009 issue of The Lancet Infectious Diseases.
Infection control measures for patients with cancer vary widely between hospitals and countries. Available measures range from simple interventions such as hand hygiene and use of barriers, to more complicated measures involving ventilation and air-quality technologies. Furthermore, patients differ in their risk for infection.
To quantify the evidence for infection-control interventions among high-risk cancer patients and haematopoietic stem-cell transplant (HSCT) recipients, Mical Paul, MD, Unit of Infectious Diseases, Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel, and colleagues did a systematic review of prospective comparative studies.
A total of 29 studies showed a reduction in all-cause mortality of 40% at 30 days post-treatment for high-risk cancer patients. In addition, there was still a 14% all-cause mortality reduction at the longest follow-up of 3 years.
Improved survival could be shown only when antibiotic and anti-fungal prophylaxis were used in conjunction with air quality or barrier isolation. Without the combination, the effect on mortality diminishes.
"On the basis of the evidence presented, the effect of protective isolation, including control of air quality, barrier isolation, and antibiotic/antifungal prophylaxis, can be estimated at a risk reduction of 40% in 30-day all-cause mortality. These results apply similarly to patients after allogeneic or autologous HSCT and for patients treated for acute leukaemia, but not for lower-risk patients," the authors wrote.
"Since prophylaxis has the highest effect within this multifaceted intervention, efforts should be directed at administering effective prophylaxis. We could not show an independent contribution of barrier precautions. However, they might be more important in the present day, given the high rates of resistant pathogens in hospitals. Barrier precautions might increase the efficacy of prophylaxis and allow better empirical treatment by reducing cross-transmission of resistant nosocomial pathogens."
The authors also analysed 11 non-randomised prospective studies which assesses inpatient versus outpatient management following HSCT transplantation. All cause mortality was found to be 28% lower in outpatients. "The safety and potential benefit of outpatient management in observational studies calls for the assessment of outpatient versus inpatient management of HSCT in randomised controlled trials."
SOURCE: The Lancet Infectious Diseases
E-Mail this DGNews to a colleague
