Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA; Alfa Institute of Biomedical Sciences, Athens, Greece; Society of Junior Doctors, Athens, Greece.
Society of Junior Doctors, Athens, Greece.
Int J Antimicrob Agents. 2019 Jun;53(6):746-754. doi: 10.1016/j.ijantimicag.2019.01.004. Epub 2019 Jan 10.
Complicated intra-abdominal infections (cIAIs) are common and confer significant morbidity, mortality and costs. In this era of evolving antimicrobial resistance, selection of appropriate empirical antimicrobials is paramount. This systematic review and meta-analysis of randomised controlled trials compared the effectiveness and safety of fluoroquinolone (FQ)-based versus β-lactam (BL)-based regimens for the treatment of patients with cIAIs. Primary outcomes were treatment success in the clinically evaluable (CE) population and all-cause mortality in the intention-to-treat (ITT) population. Subgroup analyses were performed based on specific antimicrobials, infection source and isolated pathogens. Seven trials (4125 patients) were included. FQ-based regimens included moxifloxacin (four studies) or ciprofloxacin/metronidazole (three studies); BL-based regimens were ceftriaxone/metronidazole (three studies), carbapenems (two studies) or piperacillin/tazobactam (two studies). There was no difference in effectiveness in the CE (2883 patients; RR = 1.00, 95% CI 0.95-1.04) or ITT populations (3055 patients; RR = 0.97, 95% CI 0.94-1.01). Mortality (3614 patients; RR = 1.04, 95% CI 0.75-1.43) and treatment-related adverse events (2801 patients; RR = 0.97, 95% CI 0.70-1.33) were also similar. On subset analysis, moxifloxacin was slightly less effective than BLs in the CE (1934 patients; RR = 0.96, 95% CI 0.93-0.99) and ITT populations (1743 patients; RR = 0.94, 95% CI 0.91-0.98). Although FQ- and BL-based regimens appear equally effective and safe for the treatment of cIAIs, limited data suggest slightly inferior results with moxifloxacin. Selection of empirical coverage should be based on local bacterial epidemiology and patterns of resistance as well as antimicrobial stewardship protocols.
复杂性腹腔内感染（cIAIs）较为常见，可导致较高的发病率、死亡率和医疗费用。在当前抗菌药物耐药性不断演变的时代，选择合适的经验性抗菌药物至关重要。本项针对随机对照试验的系统评价和荟萃分析比较了氟喹诺酮（FQ）为基础与β-内酰胺（BL）为基础方案治疗复杂性腹腔内感染患者的有效性和安全性。主要结局为临床可评估人群的治疗成功率和意向治疗人群的全因死亡率。根据特定抗菌药物、感染源和分离病原体进行了亚组分析。纳入了 7 项试验（4125 例患者）。FQ 为基础的方案包括莫西沙星（4 项研究）或环丙沙星/甲硝唑（3 项研究）；BL 为基础的方案为头孢曲松/甲硝唑（3 项研究）、碳青霉烯类（2 项研究）或哌拉西林/他唑巴坦（2 项研究）。在临床可评估人群（2883 例患者；RR=1.00，95%CI 0.95-1.04）和意向治疗人群（3055 例患者；RR=0.97，95%CI 0.94-1.01）中，疗效均无差异。死亡率（3614 例患者；RR=1.04，95%CI 0.75-1.43）和治疗相关不良事件（2801 例患者；RR=0.97，95%CI 0.70-1.33）也相似。在亚组分析中，莫西沙星在临床可评估人群（1934 例患者；RR=0.96，95%CI 0.93-0.99）和意向治疗人群（1743 例患者；RR=0.94，95%CI 0.91-0.98）中的疗效略低于 BLs。FQ 和 BL 为基础的方案似乎在治疗 cIAIs 方面同样有效且安全，但有限的数据表明莫西沙星的疗效略差。经验性覆盖的选择应基于当地细菌流行病学和耐药模式以及抗菌药物管理方案。
