甲硝唑是疑似厌氧性感染患者首选的经验性抗厌氧剂。经验性甲硝唑的利弊之间的平衡尚不清楚。我们旨在评估经验性甲硝唑与安慰剂/无治疗对任何来源的严重细菌感染的成年患者的患者重要益处和危害。
我们进行了一项系统评价,采用荟萃分析和试验序贯分析的随机临床试验,评估甲硝唑与安慰剂/无治疗成人严重细菌感染住院患者的经验。审查是根据系统审查和荟萃分析(PRISMA)声明的首选报告项目进行的。Cochrane手册和建议分级,评估,开发和评估(等级)方法。在进行审查之前发布了协议和统计分析计划。
我们总共纳入了9项试验(n=1753名患者),所有这些都被裁定为具有高偏倚风险.我们发现90天内的主要结局死亡率没有差异(相对风险1.56,95%置信区间0.39-6.25)。接受甲硝唑治疗的患者较少有继发感染(相对危险度0.43,95%CI:0.27-0.68)。试验序贯分析表明,由于缺乏数据,随机误差的风险很高,所有结局的证据质量都很低.
支持在任何来源的严重细菌感染的成年患者中使用经验性甲硝唑的证据数量和质量都很低,也没有确凿的利益或伤害的证据.
Metronidazole is the preferred empirical anti-anaerobic agent for patients with suspected anaerobic infection. The balance between benefits and harms of empirical metronidazole is unclear. We aimed to assess patient-important benefits and harms of empirical metronidazole vs placebo/no treatment in adult patients with severe bacterial infection of any origin.
We conducted a systematic
review with meta-analysis and trial sequential analysis of randomized clinical trials assessing empirical metronidazole vs placebo/no treatment in adult hospitalized patients with severe bacterial infection. The
review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, the Cochrane Handbook and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. A protocol and statistical analysis plan was published prior to conducting the
review.
We included a total of nine trials (n = 1753 patients), all of which were adjudicated as having high risk of bias. We found no difference in the primary outcome mortality within 90 days (relative risk 1.56, 95% confidence interval 0.39-6.25). Fewer patients receiving metronidazole had secondary infections (relative risk 0.43, 95% CI: 0.27-0.68). Trial sequential analysis indicated high risk of random errors due to lack of data, and the quality of evidence was very low for all outcomes.
There is low quantity and quality of evidence supporting the use of empirical metronidazole in adult patients with severe bacterial infections of any origin, and no firm evidence for benefit or harm.