Publication

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

Märtson, A-G., Bakker, M., Blokzijl, H., Verschuuren, E. A. M., Berger, S. P., Span, L. F. R., van der Werf, T. S. & Alffenaar, J-W. C., 7-Jan-2020, In : BMJ Open. 10, 1, 13 p., e034940.

Research output: Contribution to journalArticleAcademicpeer-review

APA

Märtson, A-G., Bakker, M., Blokzijl, H., Verschuuren, E. A. M., Berger, S. P., Span, L. F. R., ... Alffenaar, J-W. C. (2020). Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review. BMJ Open, 10(1), [e034940]. https://doi.org/10.1136/bmjopen-2019-034940

Author

Märtson, Anne-Grete ; Bakker, Martijn ; Blokzijl, Hans ; Verschuuren, Erik A M ; Berger, Stefan P ; Span, Lambert F R ; van der Werf, Tjip S ; Alffenaar, Jan-Willem C. / Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients : a systematic review. In: BMJ Open. 2020 ; Vol. 10, No. 1.

Harvard

Märtson, A-G, Bakker, M, Blokzijl, H, Verschuuren, EAM, Berger, SP, Span, LFR, van der Werf, TS & Alffenaar, J-WC 2020, 'Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review', BMJ Open, vol. 10, no. 1, e034940. https://doi.org/10.1136/bmjopen-2019-034940

Standard

Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients : a systematic review. / Märtson, Anne-Grete; Bakker, Martijn; Blokzijl, Hans; Verschuuren, Erik A M; Berger, Stefan P; Span, Lambert F R; van der Werf, Tjip S; Alffenaar, Jan-Willem C.

In: BMJ Open, Vol. 10, No. 1, e034940, 07.01.2020.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

Märtson A-G, Bakker M, Blokzijl H, Verschuuren EAM, Berger SP, Span LFR et al. Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review. BMJ Open. 2020 Jan 7;10(1). e034940. https://doi.org/10.1136/bmjopen-2019-034940


BibTeX

@article{9e90f5c9a53545ec8ec0fe1990c9ea9a,
title = "Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients: a systematic review",
abstract = "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.",
keywords = "transplant medicine, infectious diseases, infection control, INVASIVE FUNGAL-INFECTIONS, STEM-CELL TRANSPLANT, EXTENDED VALGANCICLOVIR PROPHYLAXIS, CYTOMEGALOVIRUS-INFECTION, HIGH-RISK, RANDOMIZED-TRIAL, POPULATION PHARMACOKINETICS, VALACYCLOVIR PROPHYLAXIS, HEMATOLOGICAL PATIENTS, LIVER-TRANSPLANTATION",
author = "Anne-Grete M{\"a}rtson and Martijn Bakker and Hans Blokzijl and Verschuuren, {Erik A M} and Berger, {Stefan P} and Span, {Lambert F R} and {van der Werf}, {Tjip S} and Alffenaar, {Jan-Willem C}",
note = "{\circledC} Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.",
year = "2020",
month = "1",
day = "7",
doi = "10.1136/bmjopen-2019-034940",
language = "English",
volume = "10",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ PUBLISHING GROUP",
number = "1",

}

RIS

TY - JOUR

T1 - Exploring failure of antimicrobial prophylaxis and pre-emptive therapy for transplant recipients

T2 - a systematic review

AU - Märtson, Anne-Grete

AU - Bakker, Martijn

AU - Blokzijl, Hans

AU - Verschuuren, Erik A M

AU - Berger, Stefan P

AU - Span, Lambert F R

AU - van der Werf, Tjip S

AU - Alffenaar, Jan-Willem C

N1 - © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

PY - 2020/1/7

Y1 - 2020/1/7

N2 - 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.

AB - 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.

KW - transplant medicine

KW - infectious diseases

KW - infection control

KW - INVASIVE FUNGAL-INFECTIONS

KW - STEM-CELL TRANSPLANT

KW - EXTENDED VALGANCICLOVIR PROPHYLAXIS

KW - CYTOMEGALOVIRUS-INFECTION

KW - HIGH-RISK

KW - RANDOMIZED-TRIAL

KW - POPULATION PHARMACOKINETICS

KW - VALACYCLOVIR PROPHYLAXIS

KW - HEMATOLOGICAL PATIENTS

KW - LIVER-TRANSPLANTATION

U2 - 10.1136/bmjopen-2019-034940

DO - 10.1136/bmjopen-2019-034940

M3 - Article

VL - 10

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - e034940

ER -

ID: 111758737