Table 12.1GRADE profile: Role of empiric glycopeptide antibiotics (antibiotics chosen in the absence of an identified bacterium) in patients with central lines and suspected neutropenia or neutropenic sepsis

Quality assessmentNo of patientsEffectQuality
No of studiesDesignRisk of biasInconsistencyIndirectnessImprecisionOther considerationsEmpiric antibiotics onlyEmpiric antibiotics plus glycopeptidesRelative (95% CI)Absolute
All cause (short term) mortality
5randomised trialsserious1no serious inconsistencyserious2Serious3none37/534
(6.9%)		39/549
(7.1%)		RR 0.97 (0.61 to 1.55)2 fewer per 1000
(from 27 fewer to 38 more)		VERY LOW
Critical care
0no evidence availablenone----
Line preservation/catheter remains in situ
0no evidence availablenone----
Nephrotoxicity
5randomised trialsserious1no serious inconsistencyserious2Serious3none19/571
(3.3%)		34/589
(5.8%)		RR 0.57 (0.33 to 0.99)14 fewer per 1000
(from 0 fewer to 22 fewer)		VERY LOW
Hepatotoxicity
2randomised trialsserious1no serious inconsistencyserious2serious3none51/421
(12.1%)		90/435
(20.7%)		RR 0.53 (0.36 to 0.76)57 fewer per 1000
(from 29 fewer to 78 fewer)		VERY LOW
Length of stay
0no evidence availablenone----
Proven bacteremia
2randomised trialsserious1no serious inconsistencyserious2serious3none29/77
(37.7%)		32/73
(43.8%)		RR 0.80 (0.42 to 1.53)75 fewer per 1000
(from 218 fewer to 200 more)		VERY LOW
Antibiotic resistance
0no evidence availablenone----
1

Few studies were blinded. Sequence generation/allocation concealment were unclear in several studies.

2

Only a proportion of the participants had a central venous access device. Unclear exactly how many.

3

Low event rate.

From: Initial Treatment: guideline chapter six

Cover of Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients
Neutropenic Sepsis: Prevention and Management of Neutropenic Sepsis in Cancer Patients.
NICE Clinical Guidelines, No. 151.
National Collaborating Centre for Cancer (UK).
Copyright © National Collaborating Centre for Cancer, 2012.

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