Outpatient parenteral antimicrobial therapy with carbapenems: A systematic review

IF 14.3 1区医学 Q1 INFECTIOUS DISEASES Journal of Infection Pub Date : 2024-09-30 DOI:10.1016/j.jinf.2024.106299

Z.T. Wolie , J.A. Roberts , Y.M. Wale , S. Unwin , K. McCarthy , F.B. Sime

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Abstract

Objective

To review the literature on parenteral carbapenems in OPAT and present comprehensive evidence on their safety, efficacy, and stability.

Methods

A systematic review following PRISMA guidelines was conducted through 17 January 2024, using PubMed, Embase, Web of Science, Scopus, and the Cochrane Library to find relevant articles.

Results

Ertapenem (1 g QD) in OPAT showed high clinical (81–97%) and microbiological (67–90.9%) success rates. Ertapenem (1 g QD) was also comparable to piperacillin/tazobactam (3.375 g every 6 h) for complicated skin infections and superior to cefazolin (2 g every 8 h) and oxacillin (2 g every 4–6 h) for various infections. Ertapenem monotherapy, once daily, achieved an 81% clinical cure rate for urinary tract infections. Additionally, subcutaneous ertapenem in OPAT showed outcomes comparable to parenteral routes. Meropenem continuous infusion (CI) may also be considered safe and effective in selected patient populations; however, its use in OPAT as a CI is limited due to stability concerns.

Conclusion

Parenteral carbapenems are effective, and well-tolerated OPAT treatment options; nonetheless, further studies are warranted to optimize the stability and/or dosing regimens of meropenem and enable its wider use.

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使用碳青霉烯类药物的门诊外用抗菌疗法：系统综述。

目的回顾有关 OPAT 中肠外碳青霉烯类药物的文献，并提供有关其安全性、有效性和稳定性的全面证据：方法：使用 PubMed、Embase、Web of Science、Scopus 和 Cochrane 图书馆查找相关文章，按照 PRISMA 指南进行了系统性综述（截至 2024 年 1 月 17 日）：厄他培南（1 克 QD）在 OPAT 中的临床成功率（81%-97%）和微生物成功率（67%-90.9%）都很高。在治疗复杂性皮肤感染方面，厄他培南（1 克 QD）的疗效与哌拉西林/他唑巴坦（3.375 克，每 6 小时一次）相当；在治疗各种感染方面，厄他培南（1 克 QD）的疗效优于头孢唑啉（2 克，每 8 小时一次）和氧西林（2 克，每 4-6 小时一次）。厄他培南单药治疗尿路感染，每日一次，临床治愈率达 81%。此外，在 OPAT 中皮下注射厄他培南的疗效与肠外途径相当。美罗培南持续输注（CI）在特定患者群体中也被认为是安全有效的；但由于稳定性问题，其在 OPAT 中作为 CI 的使用受到了限制：结论：肠外碳青霉烯类是有效且耐受性良好的 OPAT 治疗选择；然而，还需要进一步研究以优化美罗培南的稳定性和/或给药方案，使其得到更广泛的应用。

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来源期刊

Journal of Infection 医学-传染病学

CiteScore

45.90

自引率

3.20%

发文量

475

审稿时长

16 days

期刊介绍： The Journal of Infection publishes original papers on all aspects of infection - clinical, microbiological and epidemiological. The Journal seeks to bring together knowledge from all specialties involved in infection research and clinical practice, and present the best work in the ever-changing field of infection. Each issue brings you Editorials that describe current or controversial topics of interest, high quality Reviews to keep you in touch with the latest developments in specific fields of interest, an Epidemiology section reporting studies in the hospital and the general community, and a lively correspondence section.