哌拉西林-他唑巴坦与碳青霉烯类药物对产 ESBL 肠杆菌血流感染住院患者的治疗效果对比:系统综述和荟萃分析。

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2024-08-21 DOI:10.1016/j.jgar.2024.08.002
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引用次数: 0

摘要

目的元分析哌拉西林-他唑巴坦与碳青霉烯类药物治疗产扩展谱β-内酰胺酶(ESBL)肠杆菌血流感染(BSI)住院患者的临床疗效:两位作者独立检索了截至 2024 年 1 月 17 日的 PubMed-MEDLINE 和 Scopus 数据库,以检索在治疗 ESBL-BSIs 住院患者时比较哌拉西林-他唑巴坦与碳青霉烯类药物的随机对照试验 (RCT) 或观察性研究。数据由两位作者独立提取,并根据 ROB 2.0 或 ROBINS-I 工具对纳入研究的质量进行独立评估。死亡率被选为主要结果。通过使用反方差法随机效应模型对混杂因素进行调整,对从研究中检索到的几率比(ORs)进行汇总,从而进行 Meta 分析:筛选了 3,418 篇文章后,对 10 项研究进行了荟萃分析(1 项 RCT 研究和 9 项回顾性观察研究;N=1,962)。哌拉西林-他唑巴坦与碳青霉烯类治疗的死亡率没有明显差异(N=6;OR 1.41;95%CI 0.96-2.07;I²=23.6%)。在对接受经验疗法的患者(5 例;OR 1.36;95%CI 0.99-1.85)或泌尿道/胆道作为主要 BSI 来源的患者(2 例;OR 1.26;95%CI 0.84-1.89)进行的亚组分析中,结果也是一致的。相反,只有在哌拉西林-他唑巴坦的患者中,死亡率才会明显升高:这项荟萃分析表明,在对混杂因素进行适当调整后,接受哌拉西林-他唑巴坦治疗的产ESBL肠杆菌BSI患者与接受碳青霉烯类治疗的患者在死亡率和临床结局方面没有明显差异。
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Piperacillin-tazobactam vs. carbapenems for treating hospitalized patients with ESBL-producing Enterobacterales bloodstream infections: A systematic review and meta-analysis

Objectives

To meta-analyse the clinical efficacy of piperacillin-tazobactam vs. carbapenems for treating hospitalized patients affected by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales bloodstream infections (BSIs).

Methods

Two authors independently searched PubMed-MEDLINE and Scopus database up to January 17, 2024, to retrieve randomized controlled trials (RCTs) or observational studies comparing piperacillin-tazobactam vs. carbapenems for the management of hospitalized patients with ESBL-BSIs. Data were independently extracted by the two authors, and the quality of included studies was independently assessed according to ROB 2.0 or ROBINS-I tools. Mortality rate was selected as primary outcome. Meta-analysis was performed by pooling odds ratios (ORs) retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method.

Results

After screening 3,418 articles, 10 studies were meta-analysed (one RCT and nine retrospective observational studies; N = 1,962). Mortality rate did not significantly differ between treatment with piperacillin-tazobactam vs. carbapenems (N = 6; OR: 1.41; 95% CI: 0.96–2.07; = 23.6%). The findings were consistent also in subgroup analyses assessing patients receiving empirical therapy (N = 5; OR: 1.36; 95% CI: 0.99–1.85), or patients having in ≥50% of cases urinary/biliary tract as the primary BSI source (N = 2; OR: 1.26; 95% CI: 0.84–1.89). Conversely, the mortality rate was significantly higher with piperacillin-tazobactam only among patients having in <50% of cases urinary/biliary tract as the primary source of BSI (N = 3; OR: 2.02; 95% CI: 1.00–4.07).

Conclusions

This meta-analysis showed that, after performing appropriate adjustments for confounders, mortality and clinical outcome in patients having ESBL-producing Enterobacterales BSIs did not significantly differ among those receiving piperacillin-tazobactam compared to those receiving carbapenems.

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来源期刊
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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