目的:耐碳青霉烯类肠杆菌科细菌越来越被认为是一个重要的公共卫生问题。头孢他啶-阿维巴坦(CAZ-AVI)和多粘菌素被认为是世界上最后的治疗选择。这是对最近发表的数据进行的首次荟萃分析,以比较CAZ-AVI与多粘菌素治疗耐碳青霉烯类肠杆菌感染的临床疗效和安全性。
方法:系统评价和荟萃分析。
方法:PubMed,系统搜索了Embase和Cochrane图书馆,对于任何语言的出版物,从数据库开始到2023年2月。
方法:包括比较CAZ-AVI与多粘菌素的临床疗效和安全性的研究。死亡率,临床成功,微生物根除和肾毒性被评估为主要结局.
方法:文献筛选,数据提取和研究质量评价由两名研究人员独立进行,另一位研究人员解决了分歧。使用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。审查经理V.5.3被用于荟萃分析。
结果:荟萃分析包括7项回顾性和4项前瞻性队列研究,纳入1111例患者。CAZ-AVI组的30天死亡率较低(风险比(RR)=0.48,95%CI为0.37至0.63,I2=10%,p<0.0001)在9项研究中有766例患者;更高的临床成功率(RR=1.71,95%CI1.33至2.20,I2=35%,p<0.0001)在4项研究中有463名患者;在7项研究中有696名患者的肾毒性较低(RR=0.42,95%CI0.23至0.77,I2=35%,p<0.05)。然而,两项研究的249例患者微生物根除率无显著差异(RR=1.16,95%CI0.97~1.39,I2=0,p>0.05).
结论:现有证据表明,与多粘菌素相比,CAZ-AVI治疗在耐碳青霉烯类肠杆菌感染的疗效和安全性方面占据主导地位。然而,分析仅包括观察性研究,高质量,大规模,多中心,需要双盲随机对照试验来证实CAZ-AVI的优势.
Carbapenem-resistant Enterobacteriaceae is increasingly recognised as a significant public health concern. Ceftazidime-avibactam (CAZ-AVI) and
polymyxins are considered as the last therapeutic options worldwide. This is the first meta-analysis of recently published data to compare the clinical efficacy and safety of CAZ-AVI with
polymyxins in the treatment of carbapenem-resistant Enterobacteriaceae infections.
Systematic
review and meta-analysis.
PubMed, Embase and the Cochrane Library were systematically searched, for publications in any language, from database inception to February 2023.
Studies comparing the clinical efficacy and safety of CAZ-AVI with
polymyxins were included. Mortality, clinical success, microbiological eradication and nephrotoxicity were assessed as the main outcomes.
Literature screening, data extraction and the quality evaluation of studies were conducted by two researchers independently, with disagreements resolved by another researcher. The Newcastle-Ottawa Scale was used to assess the bias risk for the included studies.
Review Manager V.5.3 was employed for the meta-analysis.
The meta-analysis included seven retrospective and four prospective cohort studies with 1111 patients enrolled. The CAZ-AVI groups demonstrated a lower 30-day mortality (risk ratio (RR)=0.48, 95% CI of 0.37 to 0.63, I2=10%, p<0.0001) in nine studies with 766 patients; higher clinical success (RR=1.71, 95% CI 1.33 to 2.20, I2=35%, p<0.0001) in four studies with 463 patients; and lower nephrotoxicity in seven studies with 696 patients (RR=0.42, 95% CI 0.23 to 0.77, I2=35%, p<0.05). However, no significant difference in microbiological eradication rates was observed in 249 patients from two studies (RR=1.16, 95% CI 0.97 to 1.39, I2=0, p>0.05).
Available evidence suggested that CAZ-AVI treatment held a dominant position with respect to efficacy and safety compared with polymyxins in carbapenem-resistant Enterobacteriaceae infections. However, the analysis included only observational studies, and high-quality, large-scale, multicentre, double-blind randomised controlled trials are needed to confirm the advantage of CAZ-AVI.