头孢唑林与抗葡萄球菌青霉素治疗甲氧西林敏感金黄色葡萄球菌菌血症的疗效和安全性：系统评价和荟萃分析。
Efficacy and safety of cefazolin versus antistaphylococcal penicillins for the treatment of methicillin-susceptible Staphylococcus aureus bacteremia: a systematic review and meta-analysis.
机构信息
Department of Clinical Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Clinical Pharmacy, Hangzhou First People's Hospital, Nanjing Medical University, Hangzhou, China.
出版信息
BMC Infect Dis. 2018 Oct 11;18(1):508. doi: 10.1186/s12879-018-3418-9.
BACKGROUND
Antistaphylococcal penicillins (ASPs) and cefazolin have become the most frequent choices for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) infections. However, the best therapeutic agent to treat MSSA bacteremia remains to be established.
METHODS
We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of these two regimens for the treatment of MSSA bacteremia. PubMed, EMBASE and the Cochrane Library from inception to February 2018 were searched. The primary outcome was mortality. The secondary outcomes included treatment failure, recurrence of bacteremia, adverse effects (AEs) and discontinuation due to AEs. Data were extracted and pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated.
RESULTS
A total of ten observational studies met the inclusion criteria. The results indicate that compared to ASPs, cefazolin was associated with significant reduction in mortality (OR, 0.69; 95% CI, 0.58 to 0.82; I = 3.4%) and clinical failure (OR, 0.56; 95% CI, 0.37 to 0.85; I = 44.9%) without increasing the recurrence of bacteremia (OR, 1.12; 95% CI, 0.94 to 1.34; I = 0%). There were no significant differences for the risk of anaphylaxis (OR, 0.91; 95% CI, 0.36 to 2.99; I = 0%) or hematotoxicity (OR, 0.56; 95% CI, 0.17 to 1.88; I = 0%). However, nephrotoxicity (OR, 0.36; 95% CI, 0.16 to 0.81; I = 0%) and hepatotoxicity (OR, 0.12; 95% CI, 0.04 to 0.41; I = 0%) were significantly lower in the cefazolin group. Moreover, cefazolin was associated with lower probability of discontinuation due to AEs compared with the ASPs (OR, 0.24; 95% CI, 0.12 to 0.48; I = 18%).
CONCLUSION
The results of present study favor the application of cefazolin and should be regarded as important evidence to help make clinical decisions in choosing a treatment option for treating MSSA bacteremia.
背景
抗葡萄球菌青霉素（ASPs）和头孢唑林已成为治疗耐甲氧西林金黄色葡萄球菌（MSSA）感染的最常用选择。然而，治疗 MSSA 菌血症的最佳治疗药物仍有待确定。
方法
我们进行了系统评价和荟萃分析，以评估这两种方案治疗 MSSA 菌血症的疗效和安全性。从成立到 2018 年 2 月，检索了 PubMed、EMBASE 和 Cochrane 图书馆。主要结局是死亡率。次要结局包括治疗失败、菌血症复发、不良事件（AE）和因 AE 而停药。提取数据并计算合并优势比（OR）和 95%置信区间（CI）。
结果
共有 10 项观察性研究符合纳入标准。结果表明，与 ASPs 相比，头孢唑林与死亡率显著降低相关（OR，0.69；95%CI，0.58 至 0.82；I=3.4%）和临床失败（OR，0.56；95%CI，0.37 至 0.85；I=44.9%），而不会增加菌血症复发的风险（OR，1.12；95%CI，0.94 至 1.34；I=0%）。过敏反应（OR，0.91；95%CI，0.36 至 2.99；I=0%）或血液毒性（OR，0.56；95%CI，0.17 至 1.88；I=0%）的风险无显著差异。然而，头孢唑林组的肾毒性（OR，0.36；95%CI，0.16 至 0.81；I=0%）和肝毒性（OR，0.12；95%CI，0.04 至 0.41；I=0%）显著降低。此外，与 ASPs 相比，头孢唑林因 AE 停药的可能性较低（OR，0.24；95%CI，0.12 至 0.48；I=18%）。
结论
本研究结果支持头孢唑林的应用，应作为重要证据，帮助临床决策选择治疗 MSSA 菌血症的治疗方案。
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