METHODS: A comprehensive search of PubMed, Embase, Cochrane Library and ClinicalTrials.gov was conducted until 1 October 2022. Only randomized controlled trials (RCTs) that compared the clinical efficacy and safety of novel antibiotics against carbapenems for patients with cIAIs were included.
RESULTS: Among the 11 selected RCTs, no significant differences in clinical cure rate at the test-of-cure visit were observed between the study group and the control group on analysis of the clinically evaluable population [93.6% vs 93.7%, risk ratio (RR) 1.00, 95% confidence interval (CI) 0.98-1.01; P=0.84], microbiologically evaluable population (93.0% vs 94.5%, RR 0.98, 95% CI 0.96-1.00; P=0.10) and modified intention-to-treat population (85.9% vs 87.7%, RR 0.98, 95% CI 0.95-1.01; P=0.13). All findings were consistent across the subgroup analyses and sensitivity tests. Similarly, no significant difference in microbiological eradication was observed between the study group and the control group (87.8% vs 89.7%, RR 0.98, 95% CI 0.96-1.01; P=0.18). The risk of adverse events was similar in both groups.
CONCLUSIONS: Clinical efficacy, microbiological response and safety of the novel antibiotics, including ceftazidime-avibactam, ceftolozane-tazobactam and eravacycline, are comparable to carbapenems for the treatment of patients with cIAIs. These agents can be potential therapeutic options as carbapenem-sparing antibiotics for cIAIs.
方法:在PubMed上进行了全面搜索,Embase,科克伦图书馆,和ClinicalTrials.gov,直到2022年10月1日。仅包括比较新型抗生素对碳青霉烯类患者的临床疗效和安全性的RCT。
结果:在11个选定的RCT中,在临床可评估人群的分析中,研究组与对照组之间的临床治愈率在治愈测试中没有显着差异(93.6%vs93.7%,风险比[RR],1.00;95%CI,0.98-1.01;p=0.84),微生物学可评价人群(93.0%vs94.5%;RR,0.98;95%CI,0.96-1.00;p=0.10),和改良的意向治疗人群(85.9%vs87.7%;RR,0.98;95%CI,0.95-1.01;p=0.13)。所有这些发现在亚组分析和敏感性测试中保持一致。同样,在微生物根除方面,研究组和对照组之间没有显着差异(87.8%vs89.7%;RR,0.98;95%CI,0.96-1.01;p=0.18)。两组之间的不良事件风险相似。
结论:临床疗效,微生物反应,以及新型抗生素的安全性,包括头孢他啶-阿维巴坦,头孢洛赞-他唑巴坦,在cIAI患者的治疗中,埃拉环素与碳青霉烯相当。这些药物可以作为cIAIs的碳青霉烯类抗生素的潜在治疗选择。