未经批准:耐碳青霉烯的肠杆菌科(CRE)在过去十年中已成为重大的公共卫生问题。我们的目的是探讨CRE感染患者死亡的危险因素,并关注目前关于抗微生物治疗CRE感染的证据。特别是从死亡率的角度来看。
未经评估:通过搜索EMBASE的数据库进行了系统的文献综述,PubMed,和Cochrane图书馆,以确定评估2012年至2022年发表的CRE感染的死亡率相关危险因素和抗菌方案的研究。
未经批准:总共,纳入33和28项研究,分析危险因素和抗生素治疗,分别。最常报告与CRE死亡率显著相关的危险因素是抗生素使用(92.9%;26/28研究)。合并症(88.7%;23/26研究),和医院相关因素(82.8%;24/29项研究)。在10项不含头孢他啶/阿维巴坦(CAZ-AVI)治疗的研究中,7例联合治疗的死亡率显著低于单药治疗.然而,6项研究中的5项确定CAZ-AVI单一疗法和CAZ-AVI组合疗法之间没有实质性差异。6项研究报告CAZ-AVI方案的死亡率明显低于其他方案。
未经评估:几个危险因素,特别是抗生素的使用和患者的合并症,是CRE死亡率的强危险因素。CRE感染的最佳方案仍存在争议。当碳青霉烯类抗生素时,应考虑联合治疗,粘菌素,替加环素,或给予氨基糖苷类。CAZ-AVI似乎是CRE感染的有希望的抗生素。最重要的是,应根据疾病的来源和严重程度或其他高度相关的危险因素进行个体化治疗。
UNASSIGNED: Carbapenem-resistant Enterobacteriaceae (CRE) has become a significant public health problem in the last decade. We aimed to explore the risk factors of mortality in patients with CRE infections and to focus on the current evidence on antimicrobial regimens for CRE infections, particularly from the perspective of mortality.
UNASSIGNED: A systematic literature review was performed by searching the databases of EMBASE, PubMed, and the Cochrane Library to identify studies that evaluated mortality-related risk factors and antimicrobial regimens for CRE infections published from 2012 to 2022.
UNASSIGNED: In total, 33 and 28 studies were included to analyze risk factors and antibiotic treatment, respectively. The risk factors most frequently reported as significantly associated with CRE mortality were antibiotic use (92.9%; 26/28 studies), comorbidities (88.7%; 23/26 studies), and hospital-related factors (82.8%; 24/29 studies). In 10 studies that did not contain ceftazidime/avibactam (CAZ-AVI) therapy, seven demonstrated significantly lower mortality in combination therapy than in monotherapy. However, 5 of 6 studies identified no substantial difference between CAZ-AVI monotherapy and CAZ-AVI combination therapy. Six studies reported substantially lower mortality in CAZ-AVI regimens than in other regimens.
UNASSIGNED: Several risk factors, particularly antibiotic use and patients\' comorbidities, are strong risk factors for CRE mortality. The optimal regimen for CRE infections remains controversial. Combination therapy should be considered when carbapenems, colistin, tigecycline, or aminoglycosides are administered. CAZ-AVI appears to be a promising antibiotic for CRE infections. Most importantly, treatment should be individualized according to the source and severity of the disease or other highly related risk factors.