Abstract：
BACKGROUND: This meta-analysis was conducted to compare the efficacy of ceftazidime-avibactam combination therapy with that of monotherapy in the treatment of carbapenem-resistant Gram-negative bacterial (CR-GNB).
METHODS: A literature search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was conducted until September 1, 2023. Only studies that compared CZA combination therapy with monotherapy for CR-GNB infections were included.
RESULTS: A total of 25 studies (23 retrospective observational studies and 2 prospective studies) involving 2676 patients were included. There was no significant difference in 30-day mortality between the study group receiving combination therapy and the control group receiving monotherapy (risk ratio [RR] 0.91; 95% confidence interval [CI] 0.71-1.18). In addition, no significant differences were observed between the study and the control group in terms of in-hospital mortality (RR 1.00; 95% CI 0.79-1.27), 14-day mortality (RR 1.54; 95% CI 0.24-9.91), 90-day mortality (RR 1.18; 95% CI 0.62-2.22), and clinical cure rate (RR 0.95; 95% CI 0.84-1.08). However, the combination group had a borderline higher microbiological eradication rate than the control group (RR 1.15; 95% CI 1.00-1.32).
CONCLUSIONS: Compared to monotherapy, CZA combination therapy did not yield additional clinical benefits. However, combination therapy may be associated with favorable microbiological outcomes.
METHODS: A literature search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov was conducted until September 1, 2023. Only studies that compared CZA combination therapy with monotherapy for CR-GNB infections were included.
RESULTS: A total of 25 studies (23 retrospective observational studies and 2 prospective studies) involving 2676 patients were included. There was no significant difference in 30-day mortality between the study group receiving combination therapy and the control group receiving monotherapy (risk ratio [RR] 0.91; 95% confidence interval [CI] 0.71-1.18). In addition, no significant differences were observed between the study and the control group in terms of in-hospital mortality (RR 1.00; 95% CI 0.79-1.27), 14-day mortality (RR 1.54; 95% CI 0.24-9.91), 90-day mortality (RR 1.18; 95% CI 0.62-2.22), and clinical cure rate (RR 0.95; 95% CI 0.84-1.08). However, the combination group had a borderline higher microbiological eradication rate than the control group (RR 1.15; 95% CI 1.00-1.32).
CONCLUSIONS: Compared to monotherapy, CZA combination therapy did not yield additional clinical benefits. However, combination therapy may be associated with favorable microbiological outcomes.
摘要：
背景：本荟萃分析旨在比较头孢他啶-阿维巴坦联合治疗与单药治疗耐碳青霉烯革兰氏阴性菌（CR-GNB）的疗效。
方法：PubMed的文献检索，Embase,Cochrane图书馆,和ClinicalTrials.gov进行到2023年9月1日。仅包括比较CZA联合治疗与单一治疗对CR-GNB感染的研究。
结果：共纳入25项研究（23项回顾性观察性研究和2项前瞻性研究），涉及2676例患者。接受联合治疗的研究组和接受单药治疗的对照组30天死亡率无显著差异(风险比[RR]0.91;95%置信区间[CI]0.71-1.18)。此外,在住院死亡率方面，研究组和对照组之间没有观察到显著差异(RR1.00;95%CI0.79-1.27)，14天死亡率（RR1.54；95%CI0.24-9.91），90天死亡率（RR1.18；95%CI0.62-2.22），临床治愈率（RR0.95；95%CI0.84-1.08）。然而,联合组的微生物根除率高于对照组(RR1.15;95%CI1.00-1.32).
结论：与单药治疗相比，CZA联合治疗没有产生额外的临床益处。然而,联合治疗可能与良好的微生物学结局相关.
方法：PubMed的文献检索，Embase,Cochrane图书馆,和ClinicalTrials.gov进行到2023年9月1日。仅包括比较CZA联合治疗与单一治疗对CR-GNB感染的研究。
结果：共纳入25项研究（23项回顾性观察性研究和2项前瞻性研究），涉及2676例患者。接受联合治疗的研究组和接受单药治疗的对照组30天死亡率无显著差异(风险比[RR]0.91;95%置信区间[CI]0.71-1.18)。此外,在住院死亡率方面，研究组和对照组之间没有观察到显著差异(RR1.00;95%CI0.79-1.27)，14天死亡率（RR1.54；95%CI0.24-9.91），90天死亡率（RR1.18；95%CI0.62-2.22），临床治愈率（RR0.95；95%CI0.84-1.08）。然而,联合组的微生物根除率高于对照组(RR1.15;95%CI1.00-1.32).
结论：与单药治疗相比，CZA联合治疗没有产生额外的临床益处。然而,联合治疗可能与良好的微生物学结局相关.
