Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania 'Luigi Vanvitelli', Naples, Italy.
Infectious Diseases Unit, AORN Sant'Anna e San Sebastiano, Caserta, Italy.
Int J Antimicrob Agents. 2019 Dec;54(6):735-740. doi: 10.1016/j.ijantimicag.2019.08.025. Epub 2019 Aug 31.
Clinicians may use ceftazidime/avibactam in combination with other active agents to treat infections due to carbapenem-resistant organisms, although no conclusive data support this practice. This meta-analysis compared the efficacy of ceftazidime/avibactam as monotherapy or combination therapy against infections due to carbapenem-resistant Enterobacteriaceae (CRE) and carbapenem-resistant Pseudomonas aeruginosa (CRPa). An online literature search was conducted to identify observational studies published as full papers and indexed up to February 2019 comparing the efficacy, in terms of mortality and microbiological cure rates, of ceftazidime/avibactam monotherapy or combination therapy with other active agents for infections due to CRE or CRPa. The relative risk (RR) of mortality and microbiological eradication was estimated based on pooled data from all eligible studies. Eleven studies were included in the meta-analysis accounting for 396 subjects, of whom 202 received combination therapy. The mortality rate was 38.1% for combination therapy and 30.9% for monotherapy (RR = 1.18, 95% CI 0.88-1.58; P = 0.259). Similarly, no difference was found between the two groups when analysing the rate of microbiological cure (64.9% for combination therapy vs. 63.4% for monotherapy; RR = 1.04, 95% CI 0.85-1.28, P = 0.705). Moreover, no difference was observed for both outcomes when patients infected with P. aeruginosa were excluded from the analysis. This meta-analysis suggests that use of ceftazidime/avibactam in monotherapy or combination therapy for infections due to CRE or CRPa could show a similar effect on mortality and microbiological cure rates. Studies on larger samples are needed to address this important issue.
临床医生可能会使用头孢他啶/阿维巴坦与其他活性药物联合治疗由耐碳青霉烯类肠杆菌科（CRE）和耐碳青霉烯类铜绿假单胞菌（CRPa）引起的感染，尽管没有确凿的数据支持这种做法。本荟萃分析比较了头孢他啶/阿维巴坦单药治疗或联合治疗由耐碳青霉烯类肠杆菌科和耐碳青霉烯类铜绿假单胞菌引起的感染的疗效，评估指标为死亡率和微生物学治愈率。进行了在线文献检索，以确定截至 2019 年 2 月发表的全文索引的观察性研究，比较了头孢他啶/阿维巴坦单药治疗或联合其他活性药物治疗 CRE 或 CRPa 感染的疗效，评估指标为死亡率和微生物学治愈率。根据所有合格研究的汇总数据，估计死亡率和微生物学清除率的相对风险（RR）。荟萃分析纳入了 11 项研究，共纳入 396 例患者，其中 202 例接受联合治疗。联合治疗组的死亡率为 38.1%，单药治疗组为 30.9%（RR=1.18，95%CI 0.88-1.58；P=0.259）。同样，当分析微生物学治愈率时，两组之间也没有差异（联合治疗组 64.9%，单药治疗组 63.4%；RR=1.04，95%CI 0.85-1.28，P=0.705）。此外，当排除分析中感染铜绿假单胞菌的患者时，两种治疗方案在这两个结局上也没有差异。本荟萃分析表明，头孢他啶/阿维巴坦单药或联合治疗 CRE 或 CRPa 感染可能在死亡率和微生物学治愈率方面有相似的效果。需要更大样本量的研究来解决这一重要问题。
