Prophylactic use amphotericin B use in patients with hematologic disorders complicated by neutropenia: a systematic review and meta-analysis – Scientific Reports

Data sources and searches

Duplicate articles were excluded, leaving 319 articles, and a total of 6 studies^{6,7,8,9,10,11} met the inclusion criteria and were ultimately included in our analysis (Fig. 1).

Study selection and characteristics

A total of 1019 patients with hematological diseases complicated by neutropenia were included in 6 studies^{6,7,8,9,10,11}, including 557 in the experimental group and 462 in the control group. All studies reported comparable baselines, and all studies reported fungal infection rates and mortality. The basic characteristics of the included studies are shown in Table 2, and the results of the risk of bias assessment of the included studies are shown in Fig. 2.

The percentage of risk of bias items of included studies.

Meta-analysis

Fungal infection rate of Am B versus placebo/NT

Six studies reported the fungal infection rate of prophylactic use of amphotericin B in patients with hematological disease complicated by neutropenia^{6,7,8,9,10,11}. The meta-analysis of the fixed effect model (I² = 0%, P = 0.68) showed that compared with the placebo or no-intervention group, the fungal infection rate in the experimental group was significantly decreased [RR = 0.47, 95% CI (0.32, 0.69), P < 0.0001]. Subgroup analysis showed that there was significant difference between the two groups with inh [RR = 0.43, 95% CI (0.25, 0.75), P = 0.003] or IV [RR = 0.53, 95% CI (0.32, 0.87), P = 0.01] (Fig. 3).

Forest plot of meta-analysis of fungal infection rate.

Mortality Am B versus Placebo/NT

Six studies reported the overall mortality rate of prophylactic use of amphotericin B in patients with hematological complications of neutropenia^{6,7,8,9,10,11}. The meta-analysis of the fixed effect model (I² = 40%, P = 0.14) showed that compared with the placebo or no-intervention group, the overall mortality of patients in the experimental group was slightly reduced, but there was no significant difference among groups. [RR = 0.87, 95% CI (0.61, 1.26), P = 1.23]. Subgroup analysis showed that there was no significant difference between the two groups in drug-associated mortality [RR = 1.25, 95% CI (0.63, 2.49), P = 0.52] or infection-associated mortality [RR = 0.99, 95% CI (0.56, 1.78), P = 0.99] (Fig. 4). On sensitivity analysis, after removing each study by there was no significant difference between the two groups of mortality, suggesting that these results are relatively stable.

Forest plot of the meta-analysis of the mortality.

Incidence of colonization

Two studies reported the incidence of colonization of prophylactic use of amphotericin B in patients with hematological disease complicated by neutropenia^9,10. The meta-analysis of the fixed effect model (I² = 0%, P = 0.40) showed that compared with the placebo or no intervention group, the incidence of colonization in the experimental group was slightly lower, but there was no significant difference among groups [RR = 0.51, 95% CI] (0.25, 1.03), P = 0.06] (Fig. 5).

Forest plot of the meta-analysis of incidence of colonization.

Publication bias

A visual inspection of the funnel plot indicated a symmetrical distribution, suggesting the absence of publication bias for Prophylactic use amphotericin B use in patients with hematologic disorders complicated by neutropenia (Fig. 6).

Funnel plot assessed for publication bias in the studies.