SEARCHSYSTEMATIC_REVIEWhematology, oncology

systematic_review·hematology, oncology, infectious disease, systematic review, clinical trial·PMC10132047

Nondrug Intervention for Opportunistic Infections in Individuals With Hematological Malignancy: Systematic Review

Interactive Journal of Medical Research · 8 authors, 5 centres

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TL;DR

This systematic review of six randomized controlled trials evaluated four types of nondrug interventions (specific mouthwashes, coated catheters, masks, and diet) for preventing opportunistic infections in patients with hematological malignancies.

Full summary

904 CHARS

This systematic review analyzed six randomized controlled trials with 519 total participants to assess the effectiveness of four categories of nondrug interventions in preventing opportunistic infections (OIs) in hematological cancer patients. The interventions studied were different mouthwashes (chlorhexidine, nystatin, saline, amine fluoride-stannous fluoride, sodium fluoride, herbal), chlorhexidine silver sulfadiazine-coated central venous catheters versus uncoated, well-fitted masks versus no mask, and a low-bacterial diet versus a standard hospital diet. The authors note the evidence base is extremely limited, with each intervention type represented by only one small study. The overall quality of evidence was assessed as very low, leading to the conclusion that insufficient evidence exists to support the effectiveness of these nondrug interventions for preventing OIs in this population.

STUDY TYPE

systematic_review

SPECIALTY

hematology

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AI pipeline

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100% · A

ORIGINAL PAPER

PMC10132047

Nondrug Intervention for Opportunistic Infections in Individuals With Hematological Malignancy: Systematic Review

Interactive Journal of Medical Research

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ABSTRACT

Background Hematological malignancies disturb the blood, lymph nodes, and bone marrow. Taking medications for treating opportunistic infections (OIs) in these individuals may enhance the risk of medication interaction as well as adverse drug reactions. Objective This review aims to evaluate the effectiveness of nondrug interventions in reducing OIs among patients with hematological cancers. Methods The PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), and Embase databases were searched on December 26, 2022, for all randomized controlled trials (RCTs). The primary endpoint was OIs. The quality of included studies was assessed by the Cochrane Risk-of-Bias tool. Results A total of 6 studies were included in this review with 4 interventions: (1) types of mouthwash received, (2) presence of coating on central venous catheters (CVCs), (3) use of well-fitted masks, and (4) types of diet consumed. The results were presented in 8 different comparisons: (1) chlorhexidine-nystatin versus saline mouth rinse, (2) chlorhexidine versus saline mouth rinse, (3) nystatin versus saline mouth rinse, (4) chlorhexidine silver sulfadiazine–coated CVCs versus uncoated catheters, (5) well-fitted masks versus no mask, (6) amine fluoride-stannous fluoride versus sodium fluoride mouthwash, (7) low-bacterial diet versus standard hospital diet, and (8) herbal versus placebo mouthwash. No clear differences were reported in any of the outcomes examined in the first 3 comparisons. There were also no clear differences in the rate of catheter-related bloodstream infection or insertion site infection between the use of chlorhexidine silver sulfadiazine–coated CVCs versus uncoated catheters in the patients. Further, no significant differences were seen between patients who used a well-fitted mask and those without a mask in the incidence of OI. The all-cause mortality and mortality due to OI were similar between the 2 groups. There was no clear difference in all-cause mortality, although common adverse effects were reported in patients who used sodium fluoride mouthwash compared with those using amine fluoride-stannous fluoride mouthwash. There was no evidence of any difference in the incidence of possible invasive aspergillosis or candidemia between patients who consumed a low-bacterial diet and a standard diet. For the last comparison, no significant difference was seen between patients who received herbal and placebo mouthwash. Conclusions Very limited evidence was available to measure the effectiveness of nondrug interventions in hematological cancers. The effectiveness of the interventions included in this review needs to be evaluated further in high-quality RCTs in a dedicated setting among patients with hematological malignancies. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020169186; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=169186

CITATION EXPORT

Nor Asiah Muhamad, Nur Hasnah Ma'amor, Normi Mustapha et al.. Nondrug Intervention for Opportunistic Infections in Individuals With Hematological Malignancy: Systematic Review. Interactive Journal of Medical Research. (2023). https://doi.org/10.2196/43969

AUTHORS

8 · 5 CENTRES

Nor Asiah Muhamad, Nur Hasnah Ma'amor, Normi Mustapha, Fatin Norhasny Leman, Izzah Athirah Rosli, Marilyn Umar, Tahir Aris, Nai Ming Lai

1 Sector for Evidence-based Healthcare National Institutes of Health Ministry of Health Shah Alam Malaysia
2 Faculty Science and Technology Open University Kuala Lumpur Malaysia
3 Non-Communicable Disease Section, Sarawak State Health Department Ministry of Health Sarawak Malaysia
4 Director's Office, Institutes for Medical Research National Institutes of Health Ministry of Health Shah Alam Malaysia
5 School of Medicine, Faculty of Health & Medical Sciences Taylor's University Subang Jaya Malaysia

EDITOR / REVIEWER

Amaryllis Mavragani, Aliza Mohd Yacob, Vincent Gosselin Boucher, Kim An Nguyen