{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:00:03Z","timestamp":1790316003525,"version":"4.1.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Empirical broad-spectrum antibiotics are standard care for febrile neutropenia, but prolonged treatment until neutrophil recovery may increase antimicrobial resistance, toxicity,\n                      <jats:italic>Clostridioides difficile<\/jats:italic>\n                      infection, fungal superinfection, and healthcare burden. Whether antibiotics can be safely discontinued before neutrophil recovery remains uncertain.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We systematically reviewed randomized controlled trials comparing early or short-course discontinuation of empirical antibacterial therapy with continuation until neutrophil recovery or an extended fixed course in patients with cancer and febrile neutropenia. MEDLINE, Embase, Cochrane CENTRAL, and\n                      <jats:uri>ClinicalTrials.gov<\/jats:uri>\n                      were searched from inception. Data were pooled using random-effects models. Risk of bias was assessed using the Cochrane RoB 2 tool. Co-primary outcomes were days of antibiotic therapy and all-cause mortality. The review was registered in PROSPERO (CRD420261434782).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifteen trials involving 1,692 participants (1,679 contributing to the mortality analysis) were included. Early discontinuation reduced antibiotic exposure by a mean of 3.43\u202fdays (95% CI\u202f\u2212\u202f5.59 to \u22121.27; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f87.1%), with a larger reduction in children (\u22125.04\u202fdays, 95% CI\u202f\u2212\u202f8.55 to \u22121.54) than adults (\u22121.52\u202fdays, 95% CI\u202f\u2212\u202f3.49 to 0.44; subgroup\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.0002). All-cause mortality did not differ between groups (Peto odds ratio 1.23, 95% CI 0.64 to 2.36), and the absolute risk difference across all trials was null (0.00, 95% CI\u202f\u2212\u202f0.01 to 0.01; I\n                      <jats:sup>2<\/jats:sup>\n                      =\u202f0%). No significant differences were observed in new bloodstream infections, treatment failures, or fever recurrences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In clinically stable, afebrile patients with cancer-related febrile neutropenia, early antibiotic discontinuation shortened antibiotic exposure, particularly in children, without a detectable increase in mortality or major infectious complications. Larger adult trials are needed to confirm safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420261434782<\/jats:ext-link>\n                      , CRD420261434782.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmicb.2026.1925996","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:33:30Z","timestamp":1790314410000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early discontinuation vs. continuation of empirical antibiotics in patients with cancer and febrile neutropenia: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"17","author":[{"given":"Juan","family":"Wang","sequence":"first","affiliation":[{"name":"School of Public Health and Health Sciences, Hubei University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyi","family":"Tang","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine, Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziquan","family":"Xia","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Guilin Medical University","place":["Guilin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixuan","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine, Kangda College of Nanjing Medical University","place":["Lianyungang, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Nawsherwan","sequence":"additional","affiliation":[{"name":"School of Nursing, Shandong Xiehe University","place":["Jinan, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Hu","sequence":"additional","affiliation":[{"name":"Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e573","DOI":"10.1016\/S2352-3026(17)30211-9","article-title":"Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (how long study): an open-label, randomised, controlled phase 4 trial","volume":"4","author":"Aguilar-Guisado","year":"2017","journal-title":"Lancet Haematol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"106571","DOI":"10.1016\/j.jinf.2025.106571","article-title":"Epidemiology of resistant bacterial infections in patients with hematological malignancies or undergoing hematopoietic cell transplantation in Europe: a systematic review by the European conference on infections in leukemia (ECIL)","volume":"91","author":"Baccelli","year":"2025","journal-title":"J. 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Methodol."}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1925996\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T05:33:32Z","timestamp":1790314412000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2026.1925996\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":34,"alternative-id":["10.3389\/fmicb.2026.1925996"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2026.1925996","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"1925996"}}