Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, 80138 Naples, Italy; Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138 Naples, Italy.
Unit Emerging Infectious Disease, Ospedali dei Colli, P.O. D. Cotugno, Naples, Italy.
J Infect Public Health. 2023 Mar;16(3):376-383. doi: 10.1016/j.jiph.2023.01.009. Epub 2023 Jan 16.
The ESCMID-EUCIC guideline on decolonization of multidrug-resistant Gram-negative bacteria carriers does not recommend routine decolonization and highlights the necessity of well-powered and designed randomized clinical trials. Based on this limited evidence, we decided to conduct a scoping review with the aim of describing and discussing the last published studies investigating the efficacy and safety of decolonization therapies in drug-resistant Enterobacteriaceae carriers. Studies published in PubMed from January 1, 2017 to December 28, 2021 were retrieved. A PICO (population, intervention, comparator, outcome) framework was used for article selection as follows: Population defined as any patient of any age in any setting with screening sample yielding for drug-resistant Enterobacteriaceae; Intervention defined as any decolonization; Controls defined as patients receiving no intervention (spontaneous decolonization) or a different decolonization therapy; Outcomes defined as a microbiological, clinical, epidemiological and adverse event. A total of 679 records were initially identified, of which 647 were excluded because they were not related to decolonization therapies. Other 18 records were excluded because not related to our aims, target bacteria, or study design. A total of 12 clinical studies were included, of which 4 were randomized clinical trials and 8 were non-randomized studies. The majority of studies evaluated selective decontamination of the digestive tract or selective oropharyngeal decontamination regimens. Selected studies were characterized by high heterogeneity. Further high-quality studies with proper design and sample size calculation are warranted.
ESCMID-EUCIC 关于多重耐药革兰氏阴性菌携带者去定植的指南不建议常规去定植,并强调需要进行有力且设计合理的随机临床试验。基于这有限的证据,我们决定进行范围综述,旨在描述和讨论最近发表的研究,这些研究调查了耐药肠杆菌科携带者去定植疗法的疗效和安全性。从 2017 年 1 月 1 日至 2021 年 12 月 28 日,检索了在 PubMed 上发表的研究。使用 PICO(人群、干预、对照、结局)框架进行文章选择,如下所示:人群定义为任何年龄段、任何环境的任何患者,其筛查样本产生耐药肠杆菌科;干预定义为任何去定植;对照定义为未接受干预(自发去定植)或接受不同去定植疗法的患者;结局定义为微生物学、临床、流行病学和不良事件。最初确定了 679 条记录,其中 647 条因与去定植疗法无关而被排除。另外 18 条记录因与我们的目的、目标细菌或研究设计无关而被排除。共纳入 12 项临床研究,其中 4 项为随机临床试验,8 项为非随机研究。大多数研究评估了选择性消化道去污染或选择性口咽去污染方案。入选研究具有高度异质性。需要进一步进行高质量、设计合理且样本量计算恰当的研究。
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