Lal Ashima, Jaoude Philippe, El-Solh Ali A
The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.; Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.
The Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.; Western New York Respiratory Research Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA.; School of Public Health and Health Professions, Buffalo, NY, USA.
Infect Chemother. 2016 Jun;48(2):81-90. doi: 10.3947/ic.2016.48.2.81. Epub 2016 Jun 30.
The primary objective of this meta-analysis is aimed at determining whether β-lactams prolonged infusion in patients with nosocomial pneumonia (NP) results in higher cure rate and improved mortality compared to intermittent infusion.
Relevant studies were identified from searches of MEDLINE, EMBASE, and CENTRAL from inception to September 1st, 2015. All published articles which evaluated the outcome of extended/continuous infusion of antimicrobial therapy versus intermittent infusion therapy in the treatment of NP were reviewed.
A total of ten studies were included in the analysis involving 1,051 cases of NP. Prolonged infusion of β-lactams was associated with higher clinical cure rate (OR 2.45, 95% CI, 1.12, 5.37) compared to intermittent infusion. However, there was no significant difference in mortality (OR 0.85, 95% CI 0.63-1.15) between the two groups. Subgroup analysis for β-lactam subclasses and for severity of illness showed comparable outcomes.
The limited data available suggest that reduced clinical failure rates when using prolonged infusions of β-lactam antibiotics in critically ill patients with NP. More detailed studies are needed to determine the impact of such strategy on mortality in this patient population.
本荟萃分析的主要目的是确定与间歇性输注相比，医院获得性肺炎（NP）患者延长β-内酰胺类药物输注时间是否能提高治愈率并改善死亡率。
通过检索MEDLINE、EMBASE和CENTRAL数据库，从建库至2015年9月1日，确定相关研究。对所有评估延长/持续输注抗菌治疗与间歇性输注治疗在NP治疗中的结果的已发表文章进行综述。
分析共纳入10项研究，涉及1051例NP患者。与间歇性输注相比，延长β-内酰胺类药物输注时间与更高的临床治愈率相关（比值比[OR]2.45，95%置信区间[CI]1.12至5.37）。然而，两组之间的死亡率无显著差异（OR 0.85，95%CI 0.63至1.15）。β-内酰胺类亚类和疾病严重程度的亚组分析显示结果相似。
现有有限数据表明，在患有NP的重症患者中，延长β-内酰胺类抗生素输注时间可降低临床失败率。需要更详细的研究来确定该策略对该患者群体死亡率的影响。
