BACKGROUND: Invasive @entity364 are responsible for substantial morbidity and mortality among @entity1 with @entity1398 after chemotherapy. OBJECTIVE: This meta-analysis was conducted to estimate the effect of systemic antifungal prophylaxis on the frequency of invasive @entity364 in @entity1 with @entity1398 and the mortality associated with these @entity281 . METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through September 15, 2010, for English-language publications of randomized controlled trials that compared systemic antifungal prophylaxis with placebo or no treatment in @entity1 with @entity1398 . Studies involving nonsystemic antifungal agents, direct comparisons of antifungal agents, and empirical, preemptive, or salvage treatment were excluded. Data were extracted according to European Organization for Research and Treatment of @entity5 of proven, possible, or probable @entity364 . Effect measures were reported as odds ratios (ORs) for @entity364 and mortality. Outcomes were pooled using random-effects meta-analysis. Study quality was assessed based on the study setting (single center or multicenter), institutional review board approval/informed consent, randomization, description of allocation concealment, double blinding, and reporting of dropouts. RESULTS: Twenty-six trials including a total of 3979 @entity1 were included in the meta-analysis. Antifungal prophylaxis was associated with significant reductions in proven @entity364 (OR = 0.43; 95% CI, 0.31-0.60; number needed to treat [NNT] = 20) and mortality attributed to @entity364 (OR = 0.49; 95% CI, 0.30-0.80; NNT = 53). Overall mortality was not affected by antifungal prophylaxis (OR = 0.92; 95% CI, 0.74-1.14). Antifungal prophylaxis was associated with a reduction in risk for proven @entity6923 (OR = 0.28; 95% CI, 0.20-0.38), but not for @entity2381 or @entity13296 . Antifungal prophylaxis was also associated with a decreased need for antifungal therapy (OR = 0.64; 95% CI, 0.48-0.86). In an explanatory subgroup analysis of major outcomes, only recipients of a hematopoietic stem cell transplant (HSCT) had a significant likelihood of benefiting from antifungal prophylaxis in terms of reductions in risk for proven @entity281 (OR = 0.27; 95% CI, 0.16-0.44) and mortality attributed to @entity281 (OR = 0.41; 95% CI, 0.21-0.81). A metaregression analysis indicated that a multicenter (vs single-center) design and a double-blind (vs unblinded) design were significant moderators of the effect of antifungal prophylaxis on overall mortality and proven systemic @entity364 , respectively. CONCLUSIONS: Systemic antifungal prophylaxis was associated with a reduction in proven @entity364 and mortality attributed to these @entity281 in @entity1 with @entity1398 after chemotherapy. In the setting of HSCT, antifungal prophylaxis was associated with reductions in both proven @entity281 and mortality attributed to @entity281 . There was no significant association between antifungal prophylaxis and overall mortality.

Effectiveness of systemic antifungal prophylaxis in XXXX with @entity1398 after chemotherapy: a meta-analysis of randomized controlled trials.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity6923 :: ('MESH:C536777', 'Disease') :: ['Candida infections'] @entity5 :: ('MESH:D009369', 'Disease') :: ['Cancer definitions'] @entity13296 :: ('MESH:D020096', 'Disease') :: ['zygomycosis'] @entity281 :: ('MESH:D007239', 'Disease') :: ['infections'] @entity1398 :: ('MESH:D009503', 'Disease') :: ['neutropenia'] @entity364 :: ('MESH:D009181', 'Disease') :: ['fungal infections', 'fungal infection'] @entity2381 :: ('MESH:D001228', 'Disease') :: ['aspergillosis']
@entity1 :: (9606,Species) :: ['patients']
