Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea.
Korean J Intern Med. 2023 Sep;38(5):704-713. doi: 10.3904/kjim.2023.115. Epub 2023 Aug 17.
BACKGROUND/AIMS: Antimicrobial de-escalation (ADE) remains a challenging strategy in the treatment of pneumonia. We investigated the outcomes of ADE as measured by mortality and duration of the use of antibiotics in patients with culture- negative pneumonia.
We performed a systematic review and meta-analysis in accordance with PRISMA guidelines. The primary outcome was inpatient mortality.
We examined six studies comprising 11,933 subjects, of whom 1,152 received ADE. Overall, the ADE strategy was associated with a statistically lower risk of in-hospital mortality compared with non-ADE (risk ratio [RR] = 0.60, 95% confidence interval [CI] = 0.38 to 0.93). Although substantial heterogeneity was found among the included studies (I2 = 66%), a meta-regression analysis could not reveal plausible sources of heterogeneity. And ADE was associated with a shorter duration of total and initial antibiotic therapies and total length of hospital stay compared with non-ADE.
Our findings suggest that ADE seems to be significantly associated with better clinical outcomes compared with non-ADE. Caution is demanded when interpreting data of this study because of substantial between-study heterogeneity.
背景/目的：抗菌药物降级（ADE）仍然是肺炎治疗中的一项具有挑战性的策略。我们研究了培养阴性肺炎患者中，以死亡率和抗生素使用时间为衡量指标的 ADE 结果。
我们按照 PRISMA 指南进行了系统评价和荟萃分析。主要结局是住院患者死亡率。
我们研究了六项研究，共纳入 11933 名患者，其中 1152 名患者接受了 ADE。总体而言，与非 ADE 相比，ADE 策略与住院死亡率降低相关（风险比 [RR] = 0.60，95%置信区间 [CI] = 0.38 至 0.93）。尽管纳入的研究存在显著的异质性（I2 = 66%），但荟萃回归分析未能揭示出可能的异质性来源。与非 ADE 相比，ADE 与总抗生素治疗和初始抗生素治疗时间以及总住院时间更短相关。
与非 ADE 相比，我们的研究结果表明，ADE 似乎与更好的临床结局显著相关。由于研究间存在显著的异质性，因此在解释本研究的数据时需要谨慎。
