Neill Rebecca, Gillespie David, Ahmed Haroon
Division of Population Medicine, Cardiff University, Cardiff CF14 4YS, UK.
Centre for Trials Research, Cardiff University, Cardiff CF14 4YS, UK.
Antibiotics (Basel). 2022 May 6;11(5):627. doi: 10.3390/antibiotics11050627.
Antibiotic treatment failure is used as an outcome in randomised trials and observational studies of antibiotic treatment strategies and may comprise different events that indicate failure to achieve a desired clinical response. However, the lack of a universally recognised definition has led to considerable variation in the types of events included. We undertook a systematic review of published studies investigating antibiotic treatment strategies for common uncomplicated infections, aiming to describe variation in terminology and components of the antibiotic treatment failure outcomes. We searched Medline, Embase, and the Cochrane Central Register of Clinical trials for English language studies published between January 2010 and January 2021. The population of interest was ambulatory patients seen in primary care or outpatient settings with respiratory tract (RTI), urinary tract (UTI), or skin and soft tissue infection (SSTI), where different antibiotic prescribing strategies were compared, and the outcome was antibiotic treatment failure. We narratively summarised key features from eligible studies and used frequencies and proportions to describe terminology, components, and time periods used to ascertain antibiotic treatment failure outcomes. Database searches identified 2967 unique records, from which 36 studies met our inclusion criteria. This included 10 randomised controlled trials and 26 observational studies, with 20 studies of RTI, 12 of UTI, 4 of SSTI, and 2 of both RTI and SSTI. We identified three key components of treatment failure definitions: prescription changes, escalation of care, and change in clinical condition. Prescription changes were most popular in studies of UTI, while changes in clinical condition were most common in RTI and SSTI studies. We found substantial variation in the definition of antibiotic treatment failure in included studies, even amongst studies of the same infection subtype and study design. Considerable further work is needed to develop a standardised definition of antibiotic treatment failure in partnership with patients, clinicians, and relevant stakeholders.
在抗生素治疗策略的随机试验和观察性研究中，抗生素治疗失败被用作一项结果指标，它可能包含不同事件，这些事件表明未能实现预期的临床反应。然而，由于缺乏普遍认可的定义，导致纳入的事件类型存在很大差异。我们对已发表的研究进行了系统综述，这些研究调查了常见非复杂性感染的抗生素治疗策略，旨在描述抗生素治疗失败结果的术语和组成部分的差异。我们在Medline、Embase和Cochrane临床试验中央注册库中检索了2010年1月至2021年1月发表的英文研究。感兴趣的人群是在初级保健或门诊环境中就诊的门诊患者，患有呼吸道感染（RTI）、尿路感染（UTI）或皮肤及软组织感染（SSTI），比较了不同的抗生素处方策略，结果是抗生素治疗失败。我们对符合条件的研究的关键特征进行了叙述性总结，并使用频率和比例来描述用于确定抗生素治疗失败结果的术语、组成部分和时间段。数据库检索确定了2967条独特记录，其中36项研究符合我们的纳入标准。这包括10项随机对照试验和26项观察性研究，其中20项研究RTI，12项研究UTI，4项研究SSTI，2项研究RTI和SSTI。我们确定了治疗失败定义的三个关键组成部分：处方更改、护理升级和临床状况变化。处方更改在UTI研究中最常见，而临床状况变化在RTI和SSTI研究中最常见。我们发现纳入研究中抗生素治疗失败的定义存在很大差异，即使在相同感染亚型和研究设计的研究中也是如此。需要与患者、临床医生和相关利益相关者合作开展大量进一步工作，以制定抗生素治疗失败的标准化定义。
