Ezure Yukiko, Rico Veronica, Paterson David L, Hall Lisa, Harris Patrick N A, Soriano Alex, Roberts Jason A, Bassetti Matteo, Roberts Matthew J, Righi Elda, Wright Hugh
The University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia.
School of Public Health, The University of Queensland, Brisbane, Australia.
Open Forum Infect Dis. 2020 Oct 10;9(5):ofaa480. doi: 10.1093/ofid/ofaa480. eCollection 2022 May.
This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems for the treatment of complicated urinary tract infections (cUTIs), with the comparators being new antibiotics evaluated for this indication. We searched 13 electronic databases for published randomized controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed using the Population, Intervention, Comparison, Outcomes, and Study framework. Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favored the new antibiotic groups, although this was not statistically significant (risk ratio [RR], 0.91; 95% CI, 0.79-1.04). A pooled estimate examining clinical response alone showed no difference between treatment arms (RR, 1.00; 95% CI, 0.96-1.05), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR, 0.85; 95% CI, 0.79-0.91). New antibiotic treatments demonstrated a superior microbiological response compared with carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from those of carbapenems.
本系统评价和荟萃分析评估了碳青霉烯类药物治疗复杂性尿路感染（cUTIs）的临床疗效和安全性，对照药物为针对该适应症评估的新型抗生素。我们检索了13个电子数据库，查找已发表的随机对照试验（RCTs）以及已完成和/或正在进行的试验。检索词是根据人群、干预措施、对照、结局和研究框架制定的。综合治愈（临床成功和微生物清除）的合并疗效估计有利于新型抗生素组，尽管这在统计学上无显著意义（风险比[RR]，0.91；95%CI，0.79 - 1.04）。单独检查临床反应的合并估计显示各治疗组之间无差异（RR，1.00；95%CI，0.96 - 1.05），然而，新型抗生素治疗在微生物学反应方面优于碳青霉烯类药物（RR，0.85；95%CI，0.79 - 0.91）。在cUTI的临床试验中，尽管不存在碳青霉烯类耐药，但新型抗生素治疗在微生物学反应方面表现优于碳青霉烯类药物。然而，值得注意的是，新型抗生素的临床反应和安全性概况与碳青霉烯类药物并无差异。
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