Department of Pharmacy, Affiliated Hospital of Jilin Medical University, Jilin, Jilin Province, China.
Department of Pharmacy, Affiliated Hospital of Beihua University, Jilin, Jilin Province, China.
Medicine (Baltimore). 2024 Jan 19;103(3):e36938. doi: 10.1097/MD.0000000000036938.
Multidrug-resistant Escherichia coli infections are a global health challenge, notably in North America, Europe, Asia, and Africa. This systematic review and meta-analysis evaluates the effectiveness and safety of cefotaxime combined with avibactam, aiming to mitigate these infections' impact and lessen their burden on healthcare systems worldwide.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and PICO frameworks, we conducted a comprehensive literature search across 4 primary databases on May 6, 2023. Studies evaluating the efficacy and safety of cefotaxime and avibactam were included. Key outcomes included treatment success, adverse effects, and microbiological eradication. Quality assessment utilized the Cochrane Collaboration Risk of Bias instrument. Heterogeneity was analyzed using chi-square statistics and the I2 index. Both fixed- and random-effects models were applied as appropriate. Publication bias was rigorously evaluated using Egger linear regression test and funnel plot analysis, ensuring the study's integrity and reliability.
The clinical cure rate derived from 8 studies showed no significant difference between the treatment groups (odds ratio [OR] = 1.97, 95% CI: 0.69 to 1.36, P = .86). Analysis of the bacterial clearance rate from the 5 studies also indicated no significant difference (OR = 0.97, 95% CI: 0.42 to 2.25, P = .36). Notably, a reduced mortality rate favoring the experimental group was observed in 6 studies (OR = 0.64, 95% CI: 0.44 to 0.92, P = .012). Comprehensive sensitivity analyses and the assessment of publication bias strengthened the reliability of the results.
Ceftazidime combined with avibactam significantly reduced mortality among patients with multidrug-resistant Escherichia coli infections, indicating its potential as a therapeutic option, especially for carbapenem-resistant Enterobacteriaceae. However, extensive large-scale clinical trials are required to validate these findings.
多重耐药大肠杆菌感染是一个全球性的健康挑战，尤其在北美、欧洲、亚洲和非洲。本系统评价和荟萃分析评估了头孢他啶联合阿维巴坦的有效性和安全性，旨在减轻这些感染的影响，并减轻它们对全球医疗系统的负担。
根据系统评价和荟萃分析的首选报告项目和 PICO 框架，我们于 2023 年 5 月 6 日在 4 个主要数据库中进行了全面的文献检索。纳入评估头孢他啶和阿维巴坦疗效和安全性的研究。主要结局包括治疗成功率、不良反应和微生物清除率。质量评估采用 Cochrane 协作风险偏倚工具。使用卡方检验和 I2 指数分析异质性。根据需要应用固定效应模型和随机效应模型。使用 Egger 线性回归检验和漏斗图分析严格评估发表偏倚，确保研究的完整性和可靠性。
来自 8 项研究的临床治愈率显示治疗组之间无显著差异（比值比 [OR] = 1.97，95%置信区间：0.69 至 1.36，P =.86）。对 5 项研究的细菌清除率分析也表明无显著差异（OR = 0.97，95%置信区间：0.42 至 2.25，P =.36）。值得注意的是，6 项研究观察到实验组死亡率降低（OR = 0.64，95%置信区间：0.44 至 0.92，P =.012）。全面的敏感性分析和发表偏倚评估增强了结果的可靠性。
头孢他啶联合阿维巴坦显著降低了多重耐药大肠杆菌感染患者的死亡率，表明其作为一种治疗选择的潜力，特别是对碳青霉烯类耐药肠杆菌科。然而，需要进行广泛的大规模临床试验来验证这些发现。
