Han Ruiying, Teng Mengmeng, Zhang Ying, Zhang Tao, Wang Taotao, Chen Jiaojiao, Li Sihan, Yang Bo, Shi Yaling, Dong Yalin, Wang Yan
Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Pharmacol. 2021 Jun 17;12:656790. doi: 10.3389/fphar.2021.656790. eCollection 2021.
Overuse of carbapenems has led to the increasing carbapenem-resistant . It is still unknown whether other antibiotics [especially novel -lactam/β-lactamase inhibitor combinations (BL/BLIs)] are better than carbapenems in the treatment of . A systematic literature search was performed to identify randomized controlled trials (RCTs) assessing the efficacy and safety of any antibiotics on infections. We carried out a traditional paired meta-analysis to compare ceftazidime/avibactam to comparators. Network meta-analysis (NMA) was conducted to integrate direct and indirect evidence of all interventions. Moreover, cost-effectiveness analysis using a combined decision analytical Markov model was completed for the treatment of patients with complex urinary tract infection (cUTI). A total of 25 relevant RCTs were identified, comprising 15 different interventions. Ceftazidime/avibactam exhibited comparable efficacy and safety with comparators (carbapenems) in the paired meta-analysis. In the NMA, the surface under the cumulative ranking curve probabilities showed that in terms of efficacy, the interventions with the highest-ranking were meropenem/vaborbactam, meropenem, imipenem/cilastatin, ceftriaxone, ceftazidime/avibactam, and ceftolozane/tazobactam [but no significant difference between any two antibiotics ( > 0.05)]. Regarding safety, ceftazidime/avibactam had a higher incidence of adverse events than that of piperacillin/tazobactam (relative risk = 0.74, 95% confidence interval = 0.59-0.94). Based on drug and hospitalization costs in China, the incremental cost-effectiveness ratio per quality-adjusted life-year gained in the patients with cUTI for meropenem, ceftazidime/avibactam, and ceftolozane/tazobactam compared to imipenem/cilastatin were US$579, US$24569, and US$29040, respectively. The role of these BL/BLIs to serve as alternatives to carbapenems requires large-scale and high-quality studies to validate.
碳青霉烯类药物的过度使用导致耐碳青霉烯类情况日益增多。在治疗[具体病症未提及]方面，其他抗生素[尤其是新型β-内酰胺/β-内酰胺酶抑制剂复方制剂（BL/BLIs）]是否优于碳青霉烯类药物仍不明确。进行了一项系统的文献检索，以确定评估任何抗生素对[具体感染未提及]感染疗效和安全性的随机对照试验（RCTs）。我们开展了一项传统的配对荟萃分析，以比较头孢他啶/阿维巴坦与对照药物。进行了网络荟萃分析（NMA），以整合所有干预措施的直接和间接证据。此外，还使用组合决策分析马尔可夫模型完成了针对复杂性尿路感染（cUTI）患者治疗的成本效益分析。共确定了25项相关的随机对照试验，包括15种不同的干预措施。在配对荟萃分析中，头孢他啶/阿维巴坦与对照药物（碳青霉烯类药物）的疗效和安全性相当。在网络荟萃分析中，累积排序曲线下面积概率显示，在疗效方面，排名最高的干预措施依次为美罗培南/瓦博巴坦、美罗培南、亚胺培南/西司他丁、头孢曲松、头孢他啶/阿维巴坦和头孢洛扎/他唑巴坦[但任意两种抗生素之间无显著差异（P>0.05）]。在安全性方面，头孢他啶/阿维巴坦的不良事件发生率高于哌拉西林/他唑巴坦（相对风险=0.74，95%置信区间=0.59-0.94）。基于中国的药品和住院费用，与亚胺培南/西司他丁相比，美罗培南、头孢他啶/阿维巴坦和头孢洛扎/他唑巴坦在cUTI患者中每获得一个质量调整生命年的增量成本效益比分别为579美元、24569美元和29040美元。这些BL/BLIs作为碳青霉烯类药物替代品所起的作用需要大规模、高质量的研究来验证。
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