厄他培南与其他碳青霉烯类药物治疗产超广谱β-内酰胺酶肠杆菌科感染的临床疗效：系统评价和荟萃分析。

Clinical efficacy of ertapenem vs. other carbapenems for the treatment of extended-spectrum-β-lactamase-producing Enterobacterales infection: A systematic review and meta-analysis.

机构信息

Department of Internal Medicine, Chi Mei Medical Center, Tainan City, Taiwan.

Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.

出版信息

J Glob Antimicrob Resist. 2023 Jun;33:201-207. doi: 10.1016/j.jgar.2023.03.003. Epub 2023 Mar 21.

DOI:10.1016/j.jgar.2023.03.003

Abstract

OBJECTIVE

Both ertapenem and other carbapenems, including imipenem, meropenem, and doripenem, are recommended in the treatment of extended-spectrum-β-lactamase (ESBL)-producing Enterobacterales infection. However, whether ertapenem is as effective as other carbapenems for ESBL-producing Enterobacterales remains unclear. Therefore, this meta-analysis was conducted to compare the clinical efficacy of ertapenem versus other carbapenems in the treatment of ESBL-producing Enterobacterales infection.

METHODS

PubMed, Web of Science, and Cochrane Library were searched from their inception to 29 November 2022. Only studies comparing ertapenem and other carbapenems in the treatment of patients with ESBL-producing Enterobacterales infections were included.

RESULTS

A total of six studies meeting selection criteria were identified. Overall, ertapenem was associated with a significantly lower 30-d mortality when compared with other carbapenems (10.7% [46/431] vs. 17.7% [104/586]; risk ratio [RR], 0.61; 95% CI: 0.40-0.91). The ertapenem group exhibited a significantly shorter length of hospital stay than the other carbapenem groups (mean differences, -6.02 d; 95% CI, -9.39 to -2.64). No significant differences were noted between ertapenem and other carbapenem groups in terms of rates of clinical cure or improvement (RR, 1.11; 95% CI: 0.97-1.25) and microbiological eradication (RR, 1.01; 95% CI: 0.97-1.06).

CONCLUSIONS

Ertapenem could be as effective as other carbapenems in the treatment of patients with ESBL-producing Enterobacterales infections.

摘要

目的

厄他培南和其他碳青霉烯类药物，包括亚胺培南、美罗培南和多尼培南，均被推荐用于治疗产超广谱β-内酰胺酶（ESBL）的肠杆菌科感染。然而，对于产 ESBL 的肠杆菌科感染，厄他培南与其他碳青霉烯类药物的疗效是否相当尚不清楚。因此，进行了这项荟萃分析，以比较厄他培南与其他碳青霉烯类药物治疗产 ESBL 的肠杆菌科感染的临床疗效。

方法

检索了 PubMed、Web of Science 和 Cochrane Library 从建库到 2022 年 11 月 29 日的数据。仅纳入比较厄他培南与其他碳青霉烯类药物治疗产 ESBL 的肠杆菌科感染患者的研究。

结果

共纳入符合选择标准的 6 项研究。总体而言，与其他碳青霉烯类药物相比，厄他培南治疗产 ESBL 的肠杆菌科感染患者的 30 天死亡率显著降低（10.7%[46/431] vs. 17.7%[104/586]；风险比[RR]，0.61；95%CI：0.40-0.91）。厄他培南组的住院时间明显短于其他碳青霉烯组（平均差值，-6.02d；95%CI：-9.39 至-2.64）。在临床治愈率或改善率（RR，1.11；95%CI：0.97-1.25）和微生物清除率（RR，1.01；95%CI：0.97-1.06）方面，厄他培南与其他碳青霉烯类药物之间无显著差异。