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Abstract：
Ceftriaxone is an empirical antibiotic commonly used to treat pneumonia. However, its use to treat infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) is controversial given limited evidence of its clinical efficacy. The objective of this study was to compare the clinical efficacy of ceftriaxone with either ceftaroline or ceftobiprole in the treatment of pneumonia caused by MSSA. A systematic review and meta-analysis of randomised controlled trials (RCTs) comparing clinical cure in patients with pneumonia who received ceftriaxone versus those who received either ceftaroline or ceftobiprole was conducted. Patients who received ceftriaxone plus vancomycin were excluded. The PubMed, Embase and Cochrane Library databases as well as clinical trial registries were searched up to 8 June 2018. Risk differences (RDs) with 95% confidence intervals (CIs) were estimated using a random-effects model and assessing for heterogeneity (I2). A total of five RCTs met the inclusion criteria; four used ceftaroline and one used ceftobiprole. Four studies included adults and one included paediatric patients. The adult studies included non-intensive care unit patients with mild-to-moderate community-acquired pneumonia. Clinical cure was statistically lower with ceftriaxone (RD, -28.5%, 95% CI -53.5% to -3.4%; P = 0.026; I2 = 16.321%) than with ceftaroline or ceftobiprole. In conclusion, ceftriaxone use was associated with higher clinical failure of MSSA pneumonia compared with ceftaroline or ceftobiprole. This supports the notion that ceftriaxone is not an ideal agent for the treatment of MSSA infections and adds new evidence against its use for MSSA pneumonia.
摘要：
头孢曲松是通常用于治疗肺炎的经验性抗生素。然而,鉴于其临床疗效的证据有限,其用于治疗由甲氧西林敏感的金黄色葡萄球菌(MSSA)引起的感染仍存在争议.这项研究的目的是比较头孢曲松与头孢洛林或头孢比林治疗MSSA引起的肺炎的临床疗效。进行了随机对照试验（RCT）的系统评价和荟萃分析，比较了接受头孢曲松与接受头孢洛林或头孢比前列的肺炎患者的临床治愈。接受头孢曲松加万古霉素的患者被排除在外。PubMed,截至2018年6月8日，检索了Embase和Cochrane图书馆数据库以及临床试验注册中心。使用随机效应模型和异质性评估（I2）估计具有95％置信区间（CI）的风险差异（RD）。共有五个RCT符合纳入标准；四个使用头孢洛林，一个使用头孢替诺。四项研究包括成人，一项包括儿科患者。成人研究包括患有轻度至中度社区获得性肺炎的非重症监护病房患者。头孢曲松的临床治愈率在统计学上较低(RD，-28.5%，95％CI-53.5％至-3.4％；P=0.026；I2=16.321%）比头孢洛林或头孢替诺。总之,与头孢洛林或头孢替比林相比，头孢曲松的使用与MSSA肺炎的临床失败更高相关。这支持头孢曲松不是治疗MSSA感染的理想药物的观点，并为其用于MSSA肺炎增加了新的证据。
