Van Dalen, E.C., Mank, A., Leclercq, E., Mulder, R.L., Davies, M., Kersten, M.J., & Van de Wetering, M.D. (2016). Low bacterial diet versus control diet to prevent infection in cancer patients treated with chemotherapy causing episodes of neutropenia. Cochrane Database of Systematic Reviews, 4, CD006247. 

DOI Link

Purpose

STUDY PURPOSE: To determine the efficacy of a low bacterial diet (LBD) versus a control diet in preventing infection and in decreasing infection-related mortality in adult and pediatric patients with cancer receiving chemotherapy that causes episodes of neutropenia

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL (2015, Issue 4), DARE (2015, Issue 4), PubMed (from 1946 to May 2015), EMBASE (from 1980 to May 2015), CINAHL (from 1981 to May 2015), reference lists of relevant articles and conference proceedings of the American Society of Hematology (ASH) (from 2000 to 2015), European Bone Marrow Transplantation (EBMT) (from 2000 to 2015), Oncology Nursing Society (ONS) (from 2000 to 2015), International Society for Paediatric Oncology (SIOP) (from 2000 to 2014), Multinational Association of Supportive Care in Cancer (MASCC) (from 2000 to 2015), ASCO (from 2000 to 2015), ICAAC (from 2000 to 2015), European Society for Clinical Nutrition and Metabolism (ESPEN) (from 2000 to 2015), American Society for Parenteral and Enteral Nutrition (ASPEN) (from 2000 to 2015), European Hematology Association (EHA) (from 2000 to 2015), National Institutes of Health Register via clinicaltrials.gov (May 2016), International Standard Randomized Controlled Trial Number (ISRCTN) Register

INCLUSION CRITERIA: Randomized, controlled trials (RCTs) comparing the use of an LBD versus a control diet in regard to infection rate

EXCLUSION CRITERIA: None stated

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 3
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: No new literature identified since previous Cochrane review

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 3
  • TOTAL PATIENTS INCLUDED IN REVIEW = 192 patients
  • KEY SAMPLE CHARACTERISTICS: Adult and pediatric patients undergoing chemotherapy who experienced neutropenia

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Pediatrics, elder care

Results

No evidence existed of the effect of a LBD with regard to the rate of infection. Cointerventions (e.g., protective environment, antimicrobial prophylaxis, central venous catheter care, oral care, hygiene practices, colony-stimulating factors) and outcome definitions differed between studies. In all included studies, standard policy was to give empirical antibiotics.

Conclusions

No evidence suggests that a LBD decreases the incidence of infection in patients undergoing chemotherapy who experience neutropenia. However, the evidence was not robust enough for the authors to conclude that no benefit existed, so the possibility of benefit/no benefit was inconclusive.

Limitations

  • Limited search
  • Mostly low quality/high risk of bias studies

Nursing Implications

A LBD is not recommended for patients undergoing chemotherapy who experience episodes of neutropenia. Further research is indicated to conclude that no benefit exists.

Legacy ID

6091