■我们进行了全面的系统评价和荟萃分析,以评估达托霉素(DAP)和β-内酰胺联合治疗与DAP单药治疗在革兰氏阳性球菌(GPC)引起的血流感染(BSI)患者中的临床或微生物学结果和安全性。
■我们搜索了Scopus,PubMed,EMBASE,CINAHL,和Ityuushi数据库截至2023年1月30日。结果包括全因死亡率,临床失败,和肌酸磷酸激酶(CPK)升高。
■六个队列或病例对照研究符合纳入标准,并纳入最终荟萃分析。与DAP单一疗法相比,DAP和β-内酰胺的联合疗法显着降低了由于GPC引起的所有BSI的死亡率和临床失败率(死亡率,优势比[OR]=0.63,95%置信区间[CI]=0.41-0.98;临床失败,OR=0.42,95%CI=0.22-0.81)。相比之下,两组的CPK升高发生率无显著差异(OR=0.85,95%CI=0.39~1.84).
■总之,与单独使用DAP相比,DAP和β-内酰胺类药物联合治疗可改善GPC所致BSI患者的预后.因此,它应被视为由GPC引起的BSI的经验处理的一种选择。
UNASSIGNED: We performed a comprehensive systematic
review and meta-analysis to evaluate the clinical or microbiological outcomes and safety of a combination of daptomycin (DAP) and β-lactams compared to DAP monotherapy in patients with blood stream infection (BSI) due to gram-positive cocci (GPC).
UNASSIGNED: We searched Scopus, PubMed, EMBASE, CINAHL, and Ityuushi databases up to January 30, 2023. Outcomes included all-cause mortality, clinical failure, and creatine phosphokinase (CPK) elevation.
UNASSIGNED: Six cohorts or case-control studies fulfilled the inclusion criteria and were included in the final meta-analysis. Combination therapy of DAP and β-lactams significantly reduced the mortality and clinical failure rate for all BSI due to GPC compared with the DAP monotherapy (mortality, odds ratio [OR] = 0.63, 95 % confidence interval [CI] = 0.41-0.98; clinical failure, OR = 0.42, 95 % CI = 0.22-0.81). In contrast, no significant difference was noted in the incidence of CPK elevation between the two groups (OR = 0.85, 95 % CI = 0.39-1.84).
UNASSIGNED: Altogether, combination therapy of DAP and β-lactams can improve the prognosis for patients with BSI due to GPC compared with DAP alone. Therefore, it should be considered as an option for the empirical treatment of BSI caused by GPC.