目的:评估β-内酰胺延长或连续输注(EI/CI)是否能改善已证实或疑似细菌感染儿童的临床结局。
方法:我们纳入了观察性和干预性研究,比较了18岁以下儿童的β-内酰胺EI或CI与标准输注,并报告了死亡率,医院或重症监护室的LOS,微生物治疗和/或临床治疗。数据源包括PubMed、Medline,EBM评论,EMBASE,和CINAHL,从1980年1月1日至2023年11月3日进行了搜索。包括13项研究(2,945例患者):5项随机对照试验(RCT),8项观察性研究。抗菌治疗的适应症和临床严重程度各不相同,从囊性纤维化恶化到患有菌血症的危重患儿。
结果:EI和CI与RCT死亡率降低无关(n=1,464;RR0.93,95%CI0.71,1.21),但在观察性研究中(n=833;RR0.43,95%CI0.19,0.96)。我们发现住院时间没有差异。临床和微生物治疗的结果是异质的,并报告为叙述性综述。纳入的研究是高度异质性的,限制了我们发现的力量。缺乏对临床和微生物治疗结果的共同定义,因此无法进行分析。
结论:EI和CI与儿童死亡率或LOS降低并不一致。关于临床和微生物治疗的结果是矛盾的。需要针对高风险人群的更精心设计的研究来确定这些替代给药策略的有效性。
OBJECTIVE: To assess whether beta-lactam extended or continuous beta-lactam infusions (EI/CI) improve clinical outcomes in children with proven or suspected bacterial infections.
METHODS: We included observational and interventional studies that compared beta-lactam EI or CI with standard infusions in children less than 18 years old, and reported on mortality, hospital or intensive care unit LOS, microbiological cure and/or clinical cure. Data sources included PubMed, Medline, EBM Reviews, EMBASE, and CINAHL and were searched from January 1, 1980, to November 3, 2023. Thirteen studies (2,945 patients) were included: 5 randomized control trials (RCTs), and 8 observational studies. Indications for antimicrobial therapies and clinical severity varied, ranging from cystic fibrosis exacerbation to critically ill children with bacteriemia.
RESULTS: EI and CI were not associated with a reduction in mortality in RCTs (n = 1,464; RR 0.93, 95% CI 0.71, 1.21), but were in observational studies (n = 833; RR 0.43, 95% CI 0.19, 0.96). We found no difference in hospital length of stay. Results for clinical and microbiological cures were heterogeneous and reported as narrative
review. The included studies were highly heterogeneous, limiting the strength of our findings. The lack of shared definitions for clinical and microbiological cure outcomes precluded analysis.
CONCLUSIONS: EI and CI were not consistently associated with reduced mortality or LOS in children. Results were conflicting regarding clinical and microbiological cures. More well-designed studies targeting high-risk populations are necessary to determine the efficacy of these alternative dosing strategies.