Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Clin Microbiol Infect. 2017 Oct;23(10):723-729. doi: 10.1016/j.cmi.2017.03.024. Epub 2017 Apr 1.
To compare the effectiveness and safety of antipseudomonal β-lactam empiric monotherapy for febrile neutropenia by network meta-analysis.
Searches using Pubmed, Cochrane CENTRAL, EMBASE and Web of Science Core Collection were carried out in June 2016. English articles, non-English articles, full-length articles, short articles and conference abstracts were allowed. Eligible trial design was a parallel-group individual randomization. We included febrile neutropenia adult and paediatric patients undergoing chemotherapy for either solid tumours or haematological malignancies and treated with intravenous antipseudomonal β-lactams for initial empiric therapy. Protocol was registered with PROSPERO ID 42016043377.
Of 1275 articles detected by the search, 50 studies with 10 872 patients were finally included. Among the guideline-recommended cefepime, meropenem, imipenem/cilastatin, piperacillin/tazobactam and ceftazidime; imipenem/cilastatin showed the highest odds of treatment success without modification, which was the primary endpoint, based on the random-effect model network analysis. Ceftazidime was related to lower treatment success rate without modification compared with imipenem/cilastatin with OR of 0.71 (95% CI 0.57-0.89, p 0.006). Imipenem/cilastatin showed the lowest odds of all-cause death. Patients treated with cefepime had higher risk for all-cause death compared with those treated with imipenem/cilastatin (OR 2.05, 95% CI 1.11-3.78, p 0.029). Any adverse event was significantly more prevalent in the imipenem/cilastatin arm; however, there was no difference concerning adverse events leading to discontinuation.
Imipenem/cilastatin, piperacillin/tazobactam and meropenem may be reasonable first-choice medications for empiric therapy of febrile neutropenia.
通过网络荟萃分析比较经验性抗假单胞菌β-内酰胺单药治疗发热性中性粒细胞减少症的疗效和安全性。
2016 年 6 月检索了 Pubmed、Cochrane 中心、EMBASE 和 Web of Science 核心合集。允许使用英文文章、非英文文章、全文文章、短文和会议摘要。合格的试验设计为平行组个体随机分组。我们纳入了接受化疗治疗实体瘤或血液恶性肿瘤的发热性中性粒细胞减少症的成年和儿科患者，并接受静脉注射抗假单胞菌β-内酰胺类药物进行初始经验性治疗。方案在 PROSPERO ID 42016043377 中进行了注册。
通过检索共检出 1275 篇文章，最终纳入 50 项研究共 10872 例患者。在指南推荐的头孢吡肟、美罗培南、亚胺培南/西司他丁、哌拉西林/他唑巴坦和头孢他啶中；根据随机效应模型网络分析，未调整的治疗成功率最高的是亚胺培南/西司他丁。未调整的头孢他啶与亚胺培南/西司他丁相比，治疗成功率较低，比值比（OR）为 0.71（95%置信区间 0.57-0.89，p<0.006）。亚胺培南/西司他丁发生全因死亡的几率最低。与接受亚胺培南/西司他丁治疗的患者相比，接受头孢吡肟治疗的患者发生全因死亡的风险更高（OR 2.05，95%置信区间 1.11-3.78，p=0.029）。亚胺培南/西司他丁组的所有不良事件发生率显著更高；然而，导致停药的不良事件发生率没有差异。
亚胺培南/西司他丁、哌拉西林/他唑巴坦和美罗培南可能是发热性中性粒细胞减少症经验性治疗的合理首选药物。
