Table 2.

Meta-analysis of studies comparing clinical and microbiological outcomes of patients receiving or not receiving fluoroquinolone prophylaxis

Outcome	N° of studies [References]	N° of patients in prophylaxis/no prophylaxis group	N° of events in prophylaxis (%)/no prophylaxis (%) group	RR	95% CI	p	Heterogeneity test (I2,%; p)
Mortality  Prospective studies  Retrospective studies	13 [16, 18, 20–29, 32] 4 [20, 21, 25, 26] 9 [16, 18, 22–24, 27–29, 32]	6993/5141 5931/4097 1062/1044	305 (4.4)/272 (5.3) 170 (2.9)/163 (4.0) 135 (12.7)/109 (10.4)	1.04 0.79 1.21	0.79–1.37 0.64–0.98 0.84–1.74	0.775 0.03 0.296	49.4;0.022 0.0;0.561 40.3;0.096
Mortality (high prevalence of fq resistance)	11 [16, 18, 20, 22, 24–29, 32]	1619/1502	183 (11.3)/157 (10.5)	1.16	0.89–1.50	0.275	27.6;0.18
Mortality (HSCT recipients)	6 [16, 18, 21–29, 31]	3715/2935	143 (3.8)/121 (4.2)	1.25	0.81–1.92	0.309	58.3;0.035
Mortality (Acute Leukemia patients)	7 [21, 23, 25–29]	1051/795	81 (7.7)/66 (8.3)	0.77	0.48–1.22	0.267	33.9;0.17
Mortality (patients receiving levofloxacin)	9 [16, 20, 23–25, 27–29, 32]	1359/1341	151 (11.1)/121 (9.0)	1.26	0.94–1.68	0.124	24.4;0.23
Mortality (adult patients)	10 [16, 18, 20–23, 26–29]	6754/4913	289 (4.3)/260 (5.3)	1.02	0.76–1.37	0.913	56.2;0.015
Mortality (pediatric patients)	3 [24, 25, 32]	238/228	16 (6.7)/12 (5.3)	1.25	0.51–3.04	0.623	18.4;0,294
Febrile neutropenia events  Prospective studies  Retrospective studies	12 [15, 17–19, 22, 23, 25–27, 29–31] 4 [15, 19, 25, 26] 8 [17, 18, 22, 23, 27, 29–31]	1701/1514 678/725 1023/789	1029 (60.1)/885 (57.7) 273 (40.3)/348 (48) 756 (73.9)/537 (68)	0.88 0.82 0.90	0.81–0.96 0.65–1.05 0.81–0.99	0.006 0.12 0.028	70.5;<0.001 63.1;0.04 73.2;<0.001
Febrile neutropenia events (only HSCT recipients)	6 [15, 25–27, 29, 30]	798/764	577 (72.3)/646 (84,5)	0.83	0.71–0.96	0.028	86.6;<0.001
Febrile neutropenia events (only Acute Leukemia patients)	7 [15, 23, 25–27, 29, 30]	731/544	470 (64.3)/279 (51.3)	0.85	0.70–1.03	0.106	76.8;<0.001
Febrile neutropenia events (patients receiving levofloxacin)	8 [15, 19, 23, 25, 27, 29–31]	1339/1225	725 (54.1)/550 (48.9)	0.81	0.70–0.95	0.009	77.4;<0.001
Febrile neutropenia events (patients receiving ciprofloxacin)	3 [17, 18, 26]	232/265	191 (82.7)/232 (88.3)	0.93	0.87–1.00.87.00	0.063	0.0;0.872
Febrile neutropenia events (adult patients)	9 [17, 18, 22, 23, 26, 27, 29–31]	1048/833	776 (73.9)/573 (68)	0.90	0.82–0.99	0.028	69.4:0.001
Febrile neutropenia events (pediatric patients)	3 [15, 19, 25]	653/681	253 (38.7)/312 (45.8)	0.74	0.49–1.49–12.49	0.154	71.4;0.03
Bloodstream infections rate  Prospective studies - Retrospective studies	15 [17–19, 21–32] 4 [19, 21, 25, 26] 11 [17, 18, 22–24, 27–32]	6943/4918 5748/3916 1195/1002	1057 (15.3)/936 (19.0) 839 (14.6)/674 (17.2) 218 (18.2)/262 (26.1)	0.59 0.66 0.57	0.47–0.75 0.42–1.04 0.46–0.70	< 0.001 0.073 < 0.001	68.0;<0.001 76.3;0.005 26.1;0.19
Bloodstream infections rate (high prevalence of fq resistance)	13 [17–19, 22, 24–32]	1569/1279	265 (16.9)/344 (26.9)	0.55	0.46–0.67	< 0.001	26.1;0.18
Bloodstream infections rate (only HSCT recipients)	8 [17–19, 21, 22, 24, 31, 32]	3951/2801	598 (15.1)/554 (19.8)	0.59	0.43–0.82	0.002	76.9;<0.001
Bloodstream infections rate (only Acute Leukemia patients)	8 [21, 23, 25–30]	1158/895	190 (16.4)/157 (17.5)	0.68	0.54–0.85	0.002	8.4;0.36
Bloodstream infections rate (patients receiving levofloxacin)	10 [19, 23–25, 27–32]	1279/1076	218 (17)/240 (22.3)	0.61	0.51–0.72	< 0.001	0.0;0.52
Bloodstream infections rate (patients receiving ciprofloxacin)	3 [17, 18, 26]	232/265	12 (5.2)/45 (16.9)	0.37	0.11–1.29	0.12	62.0;0.07
Bloodstream infections rate (adult patients)	11 [17, 18, 21–23, 26–31]	6398/4383	979 (15.3)/805 (18.4)	0.59	0.44–0.78	< 0.001	71.1;<0.001
Bloodstream infections rate (pediatric patients)	4 [19, 24, 25, 32]	545/535	78/131	0.61	0.42–0.88	0.008	40.8;0.17
Isolation of fq-resistant strain	6 [18, 23, 24, 27, 29, 30]	832/649	86 (10.3)/60 (9.2)	0.87	0.34–2.20	0.77	78.0;<0.001
Isolation of fq-resistant strain (patients receiving levofloxacin)	5 [23, 24, 27, 29, 30]	655/470	78 (11.9)/33 (7.0)	1.15	0.47–2.85	0.76	66.9;0.017
Isolation of fq-resistant strain (adult patients)	5 [18, 23, 27, 29, 30]	758/579	74 (9.8)/55 (9.5)	0.71	0.25–2.01	0.517	78.3;0.001

Fq fluoroquinolone, HSCT haematopoietic stem cell transplantation