■碳青霉烯类和β-内酰胺和β-内酰胺酶抑制剂(BLBLIs)已在医院性肺炎中使用经验,但其疗效和安全性存在争议。
■我们进行了一项系统评价和荟萃分析,以评估碳青霉烯类抗生素与BLBLIs对医院性肺炎的疗效和安全性。
■PubMed,Embase,Cochrane中央控制试验登记册,CNKI,王芳,到2023年4月29日,对VIP和Sinomed进行了系统搜索,以比较碳青霉烯类抗生素与BLBLIs治疗医院性肺炎的临床试验。随机效应模型用于评估治疗对全因死亡率风险比(RR)的影响。临床反应,微生物反应,铜绿假单胞菌耐药性,不良反应(AE),和严重的不良影响。使用Cochrane偏倚风险工具评估证据的质量。审查已在INPLASY(INPLASY202340113)中注册。
■包含3306名患者的七项随机对照试验符合我们的纳入标准。我们的荟萃分析显示,全因死亡率(RR=0.88,95%置信区间[CI]=0.75-1.03,I2=0%)或临床治愈(1.02,0.96-1.09,30%)或临床失败(1.19,0.97-1.47,0%),铜绿假单胞菌耐药0.P=0.09)或碳青霉烯类抗生素组与BLBLIs组之间的不良事件(0.98,0.93-1.02,0%),但严重不良事件差异显著(RR0.83,CI0.73-0.94,0%).
■死亡率的差异,临床治愈,就医院内肺炎而言,碳青霉烯类抗生素组与BLBLIs组之间未观察到临床失败.碳青霉烯类抗生素的使用与铜绿假单胞菌耐药性的出现趋势有关,然而,差异无统计学意义。
UNASSIGNED: Carbapenems and β-lactam and β-lactamase inhibitors (BLBLIs) have been used empirically in nosocomial pneumonia, but their efficacy and safety are controversial.
UNASSIGNED: We carried out a systematic
review with meta-analysis to evaluate the efficacy and safety of carbapenems versus BLBLIs against nosocomial pneumonia.
UNASSIGNED: PubMed, Embase, Cochrane Central Register of Controlled Trials, CNKI, Wangfang, VIP and Sinomed were searched systematically through April 29, 2023 for clinical trials comparing carbapenems with BLBLIs for treatment of nosocomial pneumonia. Random-effects models were used to evaluate the impact of treatment on the risk ratio (RR) of all-cause mortality, clinical response, microbiologic response, resistance by Pseudomonas aeruginosa, adverse effects (AEs), and serious adverse effects. The quality of the evidence was assessed with the Cochrane risk of bias tool. The
review was registerted in the INPLASY (INPLASY202340113).
UNASSIGNED: Seven randomized controlled trials containing 3306 patients met our inclusion criteria Our meta-analysis showed no significant difference in all-cause mortality (RR = 0.88, 95% confidence interval [CI] = 0.75-1.03, I2 = 0%) or clinical cure (1.02, 0.96-1.09, 30%) or clinical failure (1.19, 0.97-1.47, 0%) or microbiologic clinical cure (0.98, 0.89-1.06, 40%) or Pseudomonas aeruginosa resistance (RR 2.43, CI 0.86-6.81, 49%, P = 0.09) or adverse events (0.98, 0.93-1.02, 0%) between carbapenems groups versus BLBLIs groups, but a significant difference was found for severe adverse events (RR 0.83, CI 0.73-0.94, 0%).
UNASSIGNED: Differences in the prevalence of mortality, clinical cure, or clinical failure were not observed between carbapenems groups versus BLBLIs groups in terms of nosocomial pneumonia. The use of carbapenems was linked to a tendency towards the emergence of P. aeruginosa resistance, however, no statistically significant difference was observed.