疫苗接种对抗生素使用的影响：系统评价和荟萃分析。
Impact of vaccination on antibiotic usage: a systematic review and meta-analysis.
机构信息
Department of Surgery, University of the Philippines Manila, Philippine General Hospital, Manila, Philippines; Cochrane Response, Cochrane, London, UK.
Cochrane Response, Cochrane, London, UK.
出版信息
Clin Microbiol Infect. 2019 Oct;25(10):1213-1225. doi: 10.1016/j.cmi.2019.06.030. Epub 2019 Jul 5.
BACKGROUND
Vaccines may reduce antibiotic use and the development of resistance.
OBJECTIVES
To provide a comprehensive, up-to-date assessment of the evidence base relating to the effect of vaccines on antibiotic use.
DATA SOURCES
Ovid MEDLINE, Embase, the Cochrane Library, ClinicalTrials.gov and WHO Trials Registry.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials (RCTs) and observational studies published from January 1998 to March 2018.
PARTICIPANTS
Any population.
INTERVENTIONS
Vaccines versus placebo, no vaccine or another vaccine.
METHODS
Titles, abstracts and full-texts were screened independently by two reviewers. Certainty of RCT evidence was assessed using GRADE.
RESULTS
In all, 4980 records identified; 895 full-text reports assessed; 96 studies included (24 RCTs, 72 observational). There was high-certainty evidence that influenza vaccine reduces days of antibiotic use among healthy adults (one RCT; n = 4253; rate reduction 28·1%; 95% CI 16·0-38·4); moderate-certainty evidence that influenza vaccines probably reduce antibiotic use in children aged 6 months to 14 years (three RCTs; n = 610; ratio of means 0·62; 95% CI 0·54-0·70) and probably reduce community antibiotic use in children aged 3-15 years (one RCT; n = 10 985 person-seasons; risk ratio 0·69, 95% CI 0·58-0·83); and moderate-certainty evidence that pneumococcal vaccination probably reduces antibiotic use in children aged 6 weeks to 6 years (two RCTs; n = 47 945; rate ratio 0·93, 95% CI 0·87-0·99) and reduces illness episodes requiring antibiotics in children aged 12-35 months (one RCT; n = 264; rate ratio 0·85, 95% CI 0·75-0·97). Other RCT evidence was of low or very low certainty, and observational evidence was affected by confounding.
CONCLUSIONS
The evidence base is poor. Although some vaccines may reduce antibiotic use, collection of high-quality data in future vaccine trials is needed to improve the evidence base.
PROSPERO REGISTRATION
CRD42018103881.
背景
疫苗可能减少抗生素的使用和耐药性的产生。
目的
提供疫苗对抗生素使用影响的最新证据综合评估。
数据来源
Ovid MEDLINE、Embase、Cochrane 图书馆、ClinicalTrials.gov 和世卫组织临床试验注册平台。
研究入选标准
1998 年 1 月至 2018 年 3 月发表的随机对照试验（RCT）和观察性研究。
研究对象
任何人群。
干预措施
疫苗与安慰剂、无疫苗或其他疫苗。
方法
两名审查员独立筛选标题、摘要和全文。使用 GRADE 评估 RCT 证据的确定性。
结果
共确定了 4980 条记录；评估了 895 份全文报告；纳入了 96 项研究（24 项 RCT，72 项观察性研究）。有高质量证据表明流感疫苗可减少健康成年人的抗生素使用天数（一项 RCT；n=4253；率降低 28.1%；95%CI 16.0-38.4）；中等质量证据表明流感疫苗可能减少 6 个月至 14 岁儿童的抗生素使用（三项 RCT；n=610；均数比 0.62；95%CI 0.54-0.70）和可能减少 3-15 岁儿童的社区抗生素使用（一项 RCT；n=10985 人季；风险比 0.69，95%CI 0.58-0.83）；中等质量证据表明肺炎球菌疫苗可能减少 6 周至 6 岁儿童的抗生素使用（两项 RCT；n=47945；率比 0.93，95%CI 0.87-0.99）和减少 12-35 个月儿童需要抗生素的疾病发作（一项 RCT；n=264；率比 0.85，95%CI 0.75-0.97）。其他 RCT 证据的确定性为低或极低，观察性证据受到混杂因素的影响。
结论
证据基础较差。尽管某些疫苗可能会减少抗生素的使用，但在未来的疫苗试验中需要收集高质量的数据，以改善证据基础。
PROSPERO 注册号：CRD42018103881。
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