Zhang Huan, Liang Beibei, Wang Jin, Cai Yun
Centre of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, China; College of Pharmacy, Chongqing Medical University, Chongqing 400016, China.
Centre of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, Beijing 100853, China.
Int J Antimicrob Agents. 2021 Oct;58(4):106410. doi: 10.1016/j.ijantimicag.2021.106410. Epub 2021 Jul 30.
This systematic review was conducted to compare the efficacy of non-carbapenem β-lactam/β-lactamase inhibitors (BLBLIs) versus carbapenems for the treatment of urinary tract infections (UTIs) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE). A comprehensive search of the Cochrane Library, PubMed and Embase was conducted from January 1979 to December 2020. Clinical success, microbiological success, clinical and microbiological success, and mortality were assessed as efficacy outcomes. Heterogeneity was assessed using the I statistic, and a fixed-effects or random-effects model was applied for estimation of the risk ratio (RR). A total of 1612 patients from three randomised clinical trials (RCTs) and seven cohort studies were included in the meta-analysis. There was no statistically significant difference between BLBLIs and carbapenems in clinical success (RR = 0.99; P = 0.71), clinical and microbiological success (RR = 0.97; P = 0.46) and mortality (RR = 0.63; P = 0.22). A slightly higher rate of microbiological success was observed in BLBLI group (RR = 1.06; P = 0.01), which was mainly attributed to the efficacy of ceftazidime/avibactam based on a single RCT. BLBLIs were not inferior to carbapenems, with higher microbiological success, indicating an effective alternative non-carbapenem option for the treatment of UTIs caused by ESBL-PE. More high-quality and large-scale RCTs are required to further validate these findings. [Trial registration: PROSPERO ID: CRD42021233706].
本系统评价旨在比较非碳青霉烯类β-内酰胺/β-内酰胺酶抑制剂（BLBLIs）与碳青霉烯类药物治疗产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）所致尿路感染（UTIs）的疗效。对1979年1月至2020年12月期间的Cochrane图书馆、PubMed和Embase进行了全面检索。将临床成功率、微生物学成功率、临床和微生物学成功率以及死亡率作为疗效指标进行评估。使用I统计量评估异质性，并应用固定效应或随机效应模型估计风险比（RR）。荟萃分析纳入了来自三项随机临床试验（RCTs）和七项队列研究的1612例患者。BLBLIs与碳青霉烯类药物在临床成功率（RR = 0.99；P = 0.71）、临床和微生物学成功率（RR = 0.97；P = 0.46）和死亡率（RR = 0.63；P = 0.22）方面无统计学显著差异。BLBLI组的微生物学成功率略高（RR = 1.06；P = 0.01），这主要归因于一项RCT中头孢他啶/阿维巴坦的疗效。BLBLIs不劣于碳青霉烯类药物，微生物学成功率更高，表明其是治疗ESBL-PE所致UTIs的一种有效的非碳青霉烯类替代选择。需要更多高质量、大规模的RCT来进一步验证这些发现。[试验注册号：PROSPERO ID：CRD42021233706]
