背景:目前的指南建议对无并发症的金黄色葡萄球菌菌血症(SAB)患者至少使用为期两周的抗生素治疗(DOT),但这一建议的证据尚不清楚。
目的:进行系统的文献综述,评估SAB患者推荐DOT的现有证据。
方法:数据源:我们搜索了MEDLINE,ISIWebofScience,Cochrane数据库和clinicaltrials.gov从成立到2024年3月30日。筛选合格研究的参考文献,并联系该领域的专家以获取其他文章。
方法:所有临床研究,不管设计,出版状态和语言。
方法:成人无并发症SAB患者。
方法:长(>14;>18;11-16天)与短(≤14;10-18;6-10天,分别)DOT,DOT定义为抗生素治疗的第一天到最后一天。
■使用ROBINS-I-工具评估偏倚风险。
■主要结局是90天全因死亡率。仅包括显示死亡率调整分析结果的研究。无法执行数据合成。
结果:确定了11项非随机研究符合预定的纳入标准,其中三项研究报告了调整后的效应比。只有这些被包括在最终分析中。我们没有发现任何RCT。两项对1,230名患者的研究报告了主要终点90天全因死亡率。两者均未发现更长(>14;11-16天)或更短的DOT(≤14;6-10天,分别)用于无并发症的SAB患者。两项研究调查了次要终点30天全因死亡率(>18;11-16天与10-18;6-10天,分别),没有发现统计学上的显著差异。所有纳入的研究都有中等偏倚风险。
结论:缺乏支持无并发症SAB患者的任何抗生素治疗持续时间的可靠证据。
BACKGROUND: Current guidelines recommend at least 2 weeks duration of antibiotic therapy (DOT) for patients with uncomplicated Staphylococcus aureus bacteraemia (SAB) but the evidence for this recommendation is unclear.
OBJECTIVE: To perform a systematic literature review assessing current evidence for recommended DOT for patients with SAB.
METHODS: The following are the methods used for this study.
METHODS: We searched MEDLINE, ISI Web of Science, the Cochrane Database and clinicaltrials.gov from inception to March 30, 2024. References of eligible studies were screened and experts in the field contacted for additional articles.
METHODS: All clinical studies, regardless of design, publication status and language.
METHODS: Adult patients with uncomplicated SAB.
METHODS: Long (>14 days; >18 days; 11-16 days) vs. short (≤14 days; 10-18 days; 6-10 days, respectively) DOT with the DOT being defined as the first until the last day of antibiotic therapy.
UNASSIGNED: Risk of bias was assessed using the ROBINS-I-tool.
UNASSIGNED: The primary outcome was 90-day all-cause mortality. Only studies presenting results of adjusted analyses for mortality were included. Data synthesis could not be performed.
RESULTS: Eleven nonrandomized studies were identified that fulfilled the pre-defined inclusion criteria, of which three studies reported adjusted effect ratios. Only these were included in the final analysis. We did not find any RCT. Two studies with 1230 patients reported the primary endpoint 90-day all-cause mortality. Neither found a statistically significant superiority for longer (>14 days; 11-16 days) or shorter DOT (≤14 days; 6-10 days, respectively) for patients with uncomplicated SAB. Two studies investigated the secondary endpoint 30-day all-cause mortality (>18 days; 11-16 days vs. 10-18 days; 6-10 days, respectively) and did not find a statistically significant difference. All included studies had a moderate risk of bias.
CONCLUSIONS: Sound evidence that supports any duration of antibiotic treatment for patients with uncomplicated SAB is lacking.