Abstract：
BACKGROUND: The best treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still a matter of debate.
OBJECTIVE: To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT).
METHODS: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023.
METHODS: Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT.
METHODS: Patients with infections due to CRAB.
METHODS: Cefiderocol in monotherapy or in combination with other potentially active agents or BAT.
UNASSIGNED: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies.
UNASSIGNED: We conducted a meta-analysis pooling risk ratios (RRs) through random effect models.
RESULTS: We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38-47%), the rate of microbiological failure 48% (95% CI 31-65%), the clinical failure rate 43% (95% CI 32-55%), and the rate of ADRs was 3% (95% CI 1-6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43-0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57-0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09-0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate.
CONCLUSIONS: Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections.
OBJECTIVE: To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT).
METHODS: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023.
METHODS: Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT.
METHODS: Patients with infections due to CRAB.
METHODS: Cefiderocol in monotherapy or in combination with other potentially active agents or BAT.
UNASSIGNED: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies.
UNASSIGNED: We conducted a meta-analysis pooling risk ratios (RRs) through random effect models.
RESULTS: We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38-47%), the rate of microbiological failure 48% (95% CI 31-65%), the clinical failure rate 43% (95% CI 32-55%), and the rate of ADRs was 3% (95% CI 1-6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43-0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57-0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09-0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate.
CONCLUSIONS: Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections.
摘要：
背景：耐碳青霉烯鲍曼不动杆菌（CRAB）感染的最佳治疗方法仍存在争议。
目的：描述头孢地洛治疗CRAB感染的患者的结局，并比较头孢地洛与最佳可用疗法（BAT）的疗效。
方法：我们搜索了MEDLINE，Cochrane图书馆和EMBASE筛选截至2023年9月发表的原始报告研究合格标准：RCT和观察性研究调查30天死亡率，临床失败,头孢地洛或BAT参与者治疗的患者的微生物学失败或ADRs发生率：因CRAB干预而感染的患者：头孢地洛单药或与其他潜在活性剂联合使用或BAT对BIAS风险的评估：我们使用Cochrane偏差风险工具进行RCT，和纽卡斯尔渥太华量表进行观察研究。
■我们通过随机效应模型进行了荟萃分析，汇集了风险比（RR）。
结果：我们筛选了801份原始报告，和18项研究(2项随机对照试验，13项队列研究和3项病例系列)纳入分析，总共733名接受头孢地洛治疗的患者，和473接收BAT。在接受头孢地洛的患者中，30天死亡率为42%（95%CI38-47%），微生物失败率48%（95%CI31-65%），临床失败率43%（95%CI32-55%），不良反应发生率为3%(95%CI1-6%)。与接受联合治疗的患者相比，接受头孢地洛单药治疗的患者的死亡率较低（RR：0.64；95％CI：0.43-0.94，p=0.024）。我们发现，与BAT相比，头孢地洛治疗组的死亡率显着降低（RR：0.74；95％CI：0.57-0.95，p=0.02），ADR发生率降低（RR：0.28；95％CI：0.09-0.91，p=0.03）。在微生物学和临床失败率方面没有观察到差异。
结论：我们的数据加强了头孢地洛在CRAB感染中的疗效和安全性。
目的：描述头孢地洛治疗CRAB感染的患者的结局，并比较头孢地洛与最佳可用疗法（BAT）的疗效。
方法：我们搜索了MEDLINE，Cochrane图书馆和EMBASE筛选截至2023年9月发表的原始报告研究合格标准：RCT和观察性研究调查30天死亡率，临床失败,头孢地洛或BAT参与者治疗的患者的微生物学失败或ADRs发生率：因CRAB干预而感染的患者：头孢地洛单药或与其他潜在活性剂联合使用或BAT对BIAS风险的评估：我们使用Cochrane偏差风险工具进行RCT，和纽卡斯尔渥太华量表进行观察研究。
■我们通过随机效应模型进行了荟萃分析，汇集了风险比（RR）。
结果：我们筛选了801份原始报告，和18项研究(2项随机对照试验，13项队列研究和3项病例系列)纳入分析，总共733名接受头孢地洛治疗的患者，和473接收BAT。在接受头孢地洛的患者中，30天死亡率为42%（95%CI38-47%），微生物失败率48%（95%CI31-65%），临床失败率43%（95%CI32-55%），不良反应发生率为3%(95%CI1-6%)。与接受联合治疗的患者相比，接受头孢地洛单药治疗的患者的死亡率较低（RR：0.64；95％CI：0.43-0.94，p=0.024）。我们发现，与BAT相比，头孢地洛治疗组的死亡率显着降低（RR：0.74；95％CI：0.57-0.95，p=0.02），ADR发生率降低（RR：0.28；95％CI：0.09-0.91，p=0.03）。在微生物学和临床失败率方面没有观察到差异。
结论：我们的数据加强了头孢地洛在CRAB感染中的疗效和安全性。
