{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:31:45Z","timestamp":1782894705025,"version":"3.54.5"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bloodstream infections (BSIs) are a major complication during pre-engraftment neutropenia in hematopoietic stem-cell transplant (HSCT) recipients. Quinolone prophylaxis reduces BSIs but increases multidrug-resistance bacterial infections. We aimed to assess the impact of discontinuing quinolone prophylaxis in adult HSCT recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a systematic review with meta-analysis. Five databases were searched on May 20, 2025. Studies were eligible for inclusion if they reported clinical characteristics of adult HSCT recipients and outcomes following the discontinuation of prophylaxis. Data extraction and quality assessment were performed independently by 2 reviewers. Meta-analysis was performed and pooled risk ratios with 95% CI calculated using a random-effects model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ten studies including 2363 HSCT recipients (1190 with and 1173 without prophylaxis) were included. Most were allogeneic-HSCT (53.1%). Prophylaxis was associated with a lower risk of BSIs due to any microorganism (pooled risk ratio: 0.69; 95% CI 0.54\u20130.87; P value = .002; I2 = 61%) and due to Gram-negative bacteria (pooled risk ratio: 0.49; 95% CI 0.33\u20130.74; P value = .0007; I2 = 71%). In the overall population, there was no significant difference in resistant infections. In patients with Gram-negative BSIs, prophylaxis was associated with a higher risk of quinolone-resistant (pooled risk ratio: 2.35; 95% CI 1.68\u20133.29; P value &amp;lt; .00001; I2 = 27%) and carbapenem-resistant microorganisms (pooled risk ratio: 5.32; 95% CI 1.08\u201326.16; P value = .04; I2 = 69%). Discontinuation was not associated with a statistically increased infection-related mortality (pooled risk ratio: 1.26; 95% CI: 0.71\u20132.23; P value = .43; I2 = 0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Discontinuation of quinolone prophylaxis was associated with an elevated incidence of BSIs, without a concomitant reduction in the overall burden of antimicrobial resistance. Importantly, infection-related mortality did not increase to a statistically significant extent. Furthermore, Gram-negative BSIs occurring after discontinuation were less likely to exhibit resistance to quinolones or carbapenems.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag358","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:19:36Z","timestamp":1780917576000},"source":"Crossref","is-referenced-by-count":0,"title":["Effect of Quinolone Prophylaxis Discontinuation During Pre-engraftment Neutropenia on Incidence, Mortality, and Etiology of Bloodstream Infections in Hematopoietic Stem-cell Transplant Recipients: A Systematic Review and Meta-analysis"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6312-6669","authenticated-orcid":false,"given":"Bruno Azevedo","family":"Randi","sequence":"first","affiliation":[{"name":"Departamento de Infectologia e Medicina Tropical, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermes Ryoiti","family":"Higashino","sequence":"additional","affiliation":[{"name":"Departamento de Infectologia e Medicina Tropical, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Leon","family":"de Godoy Macedo","sequence":"additional","affiliation":[{"name":"Departamento de Infectologia e Medicina Tropical, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7282-5453","authenticated-orcid":false,"given":"Tha\u00eds","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Departamento de Controle de Infec\u00e7\u00e3o Hospitalar do Hospital das Cl\u00ednicas HC-FMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7447-3634","authenticated-orcid":false,"given":"Bruno Garcia","family":"Pires","sequence":"additional","affiliation":[{"name":"Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Cl\u00ednicas HC-FMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0094-619X","authenticated-orcid":false,"given":"Vanderson","family":"Rocha","sequence":"additional","affiliation":[{"name":"Departamento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Cl\u00ednicas HC-FMUSP, Faculdade de Medicina, Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4195-6821","authenticated-orcid":false,"given":"Alex","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Antimicrobial Pharmacodynamics and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool , Liverpool ,","place":["UK"]},{"name":"Department of Infection and Immunity, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust , Liverpool ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Sara","family":"Levin","sequence":"additional","affiliation":[{"name":"Departamento de Infectologia e Medicina Tropical, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia Figueiredo","family":"Costa","sequence":"additional","affiliation":[{"name":"Departamento de Infectologia e Medicina Tropical, Hospital das Cl\u00ednicas HCFMUSP, Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Laborat\u00f3rio de Investiga\u00e7\u00e3o M\u00e9dica em Protozoologia, Bacteriologia e Resist\u00eancia Antimicrobiana - LIM\/49, Faculdade de Medicina FMUSP, Universidade de S\u00e3o Paulo , S\u00e3o Paulo ,","place":["Brazil"]},{"name":"Centres for Antimicrobial Optimisation Network , CAMO-Net ,","place":["Brazil"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"2026063011223677100_ofag358-B1","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.2147\/IDR.S451781","article-title":"Epidemiology, microbiology, and risk factors of bacterial bloodstream infections in patients after allogeneic hematopoietic stem cell transplantation","volume":"17","author":"Zhang","year":"2024","journal-title":"Infect Drug Resist"},{"key":"2026063011223677100_ofag358-B2","doi-asserted-by":"crossref","first-page":"5375","DOI":"10.2147\/IDR.S420310","article-title":"Microbiology and clinical outcome of bloodstream infections in patients after hematopoietic stem cell transplantation","volume":"16","author":"Song","year":"2023","journal-title":"Infect Drug Resist"},{"key":"2026063011223677100_ofag358-B3","doi-asserted-by":"crossref","first-page":"977","DOI":"10.1056\/NEJMoa044097","article-title":"Levofloxacin to prevent bacterial infection in patients with cancer and neutropenia","volume":"353","author":"Bucaneve","year":"2005","journal-title":"N Engl J Med"},{"key":"2026063011223677100_ofag358-B4","first-page":"CD004386","article-title":"Antibiotic prophylaxis for bacterial infections in afebrile neutropenic patients following chemotherapy","author":"Gafter-Gvili","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"2026063011223677100_ofag358-B5","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1038\/bmt.2009.254","article-title":"Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective. 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