Bai Xiang-Rong, Liu Jia-Ming, Jiang De-Chun, Yan Su-Ying
a Department of Pharmacy , Xuan Wu Hospital Capital Medical University , Beijing , China.
b National Clinical Research Center for Geriatric Disorder , Beijing , China.
J Chemother. 2018 May;30(3):172-178. doi: 10.1080/1120009X.2018.1425279. Epub 2018 Feb 6.
The broad spectrum antibiotic tigecycline shows promising efficacy against many multiple drug resistant (MDR) pathogens. However, its clinical efficacy in the treatment of hospital-acquired pneumonia (HAP) is unclear. Several studies have reported on the treatment failures of tigecycline monotherapy, suggesting that it may not be sufficient to control severe infections. Combination therapy has become an option to treat MDR bacterial infections. We conducted a literature search using PubMed, Cochrane Library, Embase, Elsevier and the Web of Knowledge databases up to 29 February 2017 to identify relevant published studies. Studies were considered eligible if they were a cohort study that assessed mortality and the safety of tigecycline monotherapy versus combination therapy with other antimicrobial agents for HAP. The primary outcome was treatment mortality rate, while the secondary outcomes were adverse events. Meta-analysis was done using fixed-effects models. Five trials were included. The monotherapy tigecycline had a higher mortality compared to the combination therapy group. There was a significant difference for the treatment of HAP. However, two prospective cohort studies showed that there was no significant difference in mortality rate between the tigecycline monotherapy and the tigecycline combination therapy. Three retrospective cohort studies showed that tigecycline monotherapy had a high mortality rate. Tigecycline combination therapy efficiently treats HAP. There is a great need for well-designed studies to evaluate the effectiveness and safety of combination therapies as they compare to tigecycline monotherapy.
广谱抗生素替加环素对许多多重耐药（MDR）病原体显示出有前景的疗效。然而，其在治疗医院获得性肺炎（HAP）方面的临床疗效尚不清楚。几项研究报告了替加环素单药治疗的失败案例，表明其可能不足以控制严重感染。联合治疗已成为治疗MDR细菌感染的一种选择。我们使用PubMed、Cochrane图书馆、Embase、爱思唯尔和Web of Knowledge数据库进行了文献检索，截至2017年2月29日，以识别相关的已发表研究。如果研究是一项队列研究，评估替加环素单药治疗与其他抗菌药物联合治疗HAP的死亡率和安全性，则被认为符合条件。主要结局是治疗死亡率，次要结局是不良事件。使用固定效应模型进行荟萃分析。纳入了五项试验。与联合治疗组相比，替加环素单药治疗的死亡率更高。在HAP治疗方面存在显著差异。然而，两项前瞻性队列研究表明，替加环素单药治疗与替加环素联合治疗之间的死亡率没有显著差异。三项回顾性队列研究表明，替加环素单药治疗的死亡率较高。替加环素联合治疗能有效治疗HAP。非常需要设计良好的研究来评估联合治疗与替加环素单药治疗相比的有效性和安全性。
