METHODS: This systematic literature review searched online biomedical databases for real-world studies of C/T used to treat Gram-negative respiratory tract infections (RTIs) between January 2009 and June 2020.
RESULTS: Thirty-three studies comprising 658 patients were identified. Pneumonia was the most common infection treated with C/T (85%), with a smaller number of unspecified RTIs (9%) and tracheobronchitis (5%) reported. The majority of patients had respiratory infections caused by P. aeruginosa (92.8%), of which 88.1% were multidrug-resistant. Examination of these studies demonstrated an increase in the percentage of patients receiving the recommended dose of C/T for respiratory infections (3 g q8h or renal impairment-adjusted) over time (36.8% of patients in 2017 to 71.5% in 2020). Clinical success rates ranged from 51.4 to 100%, with 10 studies (55.6% of studies reporting clinical success) reporting clinical success rates of > 70%; microbiological success rates ranged from 57.0 to 100.0%, with three studies (60.0% of studies reporting microbiological success) reporting microbiological success rates of > 70%. Thirty-day mortality ranged from 0.0 to 33.0%, with nine studies (90% of studies reporting mortality) reporting 30-day mortality of < 30%.
CONCLUSIONS: The studies identified in this review demonstrate that C/T shows similar outcomes as those seen in clinical trials, despite the higher frequency of multidrug-resistant pathogens, and comorbidities that may have been excluded from the trials.
方法:本系统文献综述在2009年1月至2020年6月期间检索了用于治疗革兰氏阴性呼吸道感染(RTIs)的C/T的真实世界研究的在线生物医学数据库。
结果:确定了包括658名患者的33项研究。肺炎是C/T治疗最常见的感染(85%),报告了较少数量的未指明的RTI(9%)和气管支气管炎(5%)。大多数患者有由铜绿假单胞菌引起的呼吸道感染(92.8%),其中88.1%为多重耐药。对这些研究的检查表明,随着时间的推移,接受推荐剂量C/T治疗呼吸道感染(3gq8h或肾功能损害调整)的患者百分比有所增加(2017年占36.8%,2020年占71.5%)。临床成功率从51.4%到100%不等,有10项研究(55.6%的研究报告临床成功)报告临床成功率>70%;微生物成功率从57.0%到100.0%,有3项研究(60.0%的研究报告微生物成功)报告微生物成功率>70%。30天死亡率为0.0-33.0%,9项研究(90%的研究报告死亡率)报告30天死亡率<30%。
结论:本综述中确定的研究表明,C/T显示出与临床试验相似的结果,尽管多重耐药病原体的出现频率较高,以及可能被排除在试验之外的合并症。