Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Department of Anaesthesia and Intensive Care, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
Acta Anaesthesiol Scand. 2023 Aug;67(7):853-868. doi: 10.1111/aas.14239. Epub 2023 Mar 28.
Piperacillin/tazobactam or meropenem are often used to treat patients with severe bacterial infections. We aimed to compare the desirable and undesirable effects of empirical and/or definitive piperacillin/tazobactam versus carbapenems in patients with severe bacterial infections.
We searched PubMed, Embase, CENTRAL, Epistemonikos, and trial registers for randomised clinical trials of empirical and/or definitive piperacillin/tazobactam versus carbapenems in adult patients with severe bacterial infection (i.e., any bacterial infection requiring hospitalisation). The primary outcome was all-cause short-term mortality within 90 days. Secondary outcomes were all-cause long-term mortality, adverse events, quality of life, days alive without or duration of life support, secondary infections, selection of fungi or resistant bacteria, and days alive and out of hospital or hospital length of stay. We calculated relative risks (RRs) using random effects and fixed effect meta-analyses along with trial sequential analyses.
We included 31 trials (n = 8790 patients) with overall high risk of bias. The RR for all-cause short-term mortality was 1.16 (95% confidence interval [CI]: 0.94-1.43, low certainty evidence), for adverse events 1.00 (98% CI: 0.96-1.04, moderate certainty evidence), for secondary infections 1.13 (98% CI: 0.76-1.68, very low certainty evidence), and for selection of fungi or resistant bacteria 1.61 (98% CI: 0.89-2.89, very low certainty evidence). There were no or limited data for the remaining outcomes.
Based on very low or low certainty evidence, piperacillin/tazobactam may be associated with less favourable outcomes in patients with severe bacterial infections as compared with carbapenems, but the information size for a robust conclusion has not been reached.
哌拉西林/他唑巴坦或美罗培南常用于治疗严重细菌感染的患者。我们旨在比较经验性和/或明确哌拉西林/他唑巴坦与碳青霉烯类药物在严重细菌感染患者中的理想和不理想的效果。
我们检索了 PubMed、Embase、CENTRAL、Epistemonikos 和试验登记处，以查找成人严重细菌感染（即需要住院治疗的任何细菌感染）患者中经验性和/或明确哌拉西林/他唑巴坦与碳青霉烯类药物的随机临床试验。主要结局是 90 天内全因短期死亡率。次要结局是全因长期死亡率、不良事件、生活质量、无生命支持或生命支持持续时间、继发感染、真菌或耐药菌选择以及存活和出院天数或住院时间。我们使用随机效应和固定效应荟萃分析以及试验序贯分析计算相对风险 (RR)。
我们纳入了 31 项试验（n=8790 名患者），整体偏倚风险较高。全因短期死亡率的 RR 为 1.16（95%置信区间 [CI]：0.94-1.43，低确定性证据），不良事件的 RR 为 1.00（98% CI：0.96-1.04，中等确定性证据），继发感染的 RR 为 1.13（98% CI：0.76-1.68，极低确定性证据），真菌或耐药菌选择的 RR 为 1.61（98% CI：0.89-2.89，极低确定性证据）。对于其余结局，没有或数据有限。
基于极低或低确定性证据，与碳青霉烯类药物相比，哌拉西林/他唑巴坦可能与严重细菌感染患者的不良结局相关，但尚未达到稳健结论的信息大小。
