Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania, Naples, Italy.
Infectious Diseases Unit, AORN Sant' Anna e San Sebastiano, Caserta, Italy.
Int J Antimicrob Agents. 2022 Mar;59(3):106512. doi: 10.1016/j.ijantimicag.2021.106512. Epub 2021 Dec 28.
To compare the clinical and microbiological outcomes of patients treated with beta-lactam monotherapy or combination therapy for Pseudomonas aeruginosa infections.
MEDLINE, Google Scholar and the Cochrane Library.
Experimental and observational studies published as full papers up to December 2020 that compared the efficacy of beta-lactams used as monotherapy or in combination with other active agents as empirical or targeted therapy for bloodstream infections or hospital-acquired pneumonia/ventilator-associated pneumonia due to P. aeruginosa were included in this meta-analysis. The outcomes evaluated were in-hospital mortality rate, 14-day- or 30-day-mortality rate, microbiological cure rate and clinical cure rate.
Of 8363 citations screened, six randomized controlled trials, six prospective cohort studies and 21 retrospective cohort studies were included in the analysis, accounting for a total of 3861 subjects. Considering the 14 studies evaluating empirical therapy, no significant difference in mortality rate was observed between the two groups [relative risk (RR) 1.06, 95% confidence interval (CI) 0.86-1.30; P=0.6]. Similar findings were obtained among the 18 studies analysing targeted therapy (RR 1.04, 95% CI 0.83-1.31; P=0.708); however, grouping the studies by design, higher mortality was observed among patients receiving monotherapy in five prospective studies (RR 1.37, 95% CI 1.06-1.79; P=0.018). Finally, no difference was observed between groups in terms of microbiological cure and clinical cure.
This meta-analysis demonstrated no difference in mortality rate, clinical cure rate and microbiological cure rate in patients treated with beta-lactam monotherapy or combination therapy for P. aeruginosa infections.
比较治疗铜绿假单胞菌感染患者使用β-内酰胺单药治疗或联合治疗的临床和微生物学结局。
MEDLINE、Google Scholar 和 Cochrane 图书馆。
本荟萃分析纳入了截至 2020 年 12 月发表的全文实验和观察性研究，这些研究比较了作为经验性或靶向治疗用于治疗由铜绿假单胞菌引起的血流感染或医院获得性肺炎/呼吸机相关性肺炎时，β-内酰胺单药治疗或与其他活性药物联合治疗的疗效。评估的结局包括住院死亡率、14 天或 30 天死亡率、微生物学治愈率和临床治愈率。
在筛选出的 8363 条引文中有 6 项随机对照试验、6 项前瞻性队列研究和 21 项回顾性队列研究被纳入分析，共纳入 3861 例患者。考虑到 14 项评估经验性治疗的研究，两组死亡率无显著差异[相对风险（RR）1.06，95%置信区间（CI）0.86-1.30；P=0.6]。在分析靶向治疗的 18 项研究中也得到了类似的发现（RR 1.04，95%CI 0.83-1.31；P=0.708）；然而，按设计对研究进行分组后，在 5 项前瞻性研究中，接受单药治疗的患者死亡率更高（RR 1.37，95%CI 1.06-1.79；P=0.018）。最后，两组在微生物学治愈率和临床治愈率方面无差异。
本荟萃分析表明，在治疗铜绿假单胞菌感染患者时，β-内酰胺单药治疗或联合治疗在死亡率、临床治愈率和微生物学治愈率方面无差异。
