Ceftazidime-avibactam versus other antimicrobial agents for treatment of Multidrug-resistant Pseudomonas aeruginosa: a systematic review and meta-analysis.

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES Infection Pub Date : 2024-08-24 DOI:10.1007/s15010-024-02371-1

Chhavi Gupta, Susan Shin-Jung Lee, Monalisa Sahu, Sudipta Mukherjee, Kuan-Sheng Wu

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Abstract

Objectives: Multidrug-resistant Pseudomonas aeruginosa (MDR-PA) is a life-threatening infection with limited treatment options. This is the first meta-analysis of recently published data to compare the clinical outcomes of ceftazidime-avibactam (CAZ-AVI) with other antimicrobial agents in treating MDR-PA infections.

Design: Systematic review and meta-analysis.

Data sources: PubMed, Embase and the Cochrane Library have been systematically reviewed, for publications in the English language, from database inception to July 2023.

Eligibility criteria for selecting studies: Studies comparing CAZ-AVI outcomes with other antimicrobial agents were included. In-hospital mortality & 30-day mortality were assessed as the main outcomes.

Data extraction and synthesis: 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.5.4 was employed for the meta-analysis.

Results: The meta-analysis included four retrospective studies, enrolling 1934 patients. The CAZ-AVI group demonstrated significantly lower in-hospital mortality (risk ratio (RR) = 0.60, 95% CI:0.37-0.97, I2 = 74%, p = 0.04) in three studies with 1444 patients and lower 30-day mortality, in 438 patients from three studies (RR = 0.54, 95% CI:0.28-1.05, I2 = 67%, p = 0.07). No significant difference in clinical success, microbiological success, length of hospital, and ICU stay was observed.

Conclusions: This meta-analysis demonstrated that CAZ-AVI treatment significantly lowered in-hospital mortality compared with other antimicrobial agents in MDR-PA infections. However, the analysis only included a few observational studies and high-quality, randomized controlled trials are needed to investigate further the scope of CAZ-AVI in MDR-PA infections.

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治疗耐多药铜绿假单胞菌的头孢唑肟-阿维菌素与其他抗菌药物的比较：系统综述和荟萃分析。

目的：耐多药铜绿假单胞菌（MDR-PA）是一种危及生命的感染，治疗方案有限。这是首次对近期发表的数据进行荟萃分析，比较头孢唑肟-阿维巴坦（CAZ-AVI）与其他抗菌药物治疗 MDR-PA 感染的临床疗效：设计：系统综述和荟萃分析：数据来源：对PubMed、Embase和Cochrane图书馆从数据库开始至2023年7月期间的英文出版物进行了系统回顾：纳入比较 CAZ-AVI 与其他抗菌药物疗效的研究。院内死亡率和30天死亡率作为主要评估结果：文献筛选、数据提取和研究质量评估由两名研究人员独立完成，出现分歧时由另一名研究人员解决。采用纽卡斯尔-渥太华量表评估纳入研究的偏倚风险。采用Review Manager V.5.4进行荟萃分析：荟萃分析包括四项回顾性研究，共纳入 1934 名患者。在三项研究的1444名患者中，CAZ-AVI组显著降低了院内死亡率（风险比（RR）=0.60，95% CI：0.37-0.97，I2=74%，P=0.04）；在三项研究的438名患者中，CAZ-AVI组显著降低了30天死亡率（RR=0.54，95% CI：0.28-1.05，I2=67%，P=0.07）。临床成功率、微生物学成功率、住院时间和重症监护室停留时间均无明显差异：这项荟萃分析表明，与其他抗菌药物相比，CAZ-AVI治疗可显著降低MDR-PA感染的院内死亡率。然而，该分析只包括了几项观察性研究，还需要高质量的随机对照试验来进一步研究 CAZ-AVI 在 MDR-PA 感染中的应用范围。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.