头孢地尔在碳青霉烯类耐药鲍曼不动杆菌感染中的单药治疗或联合治疗与最佳可用治疗的比较：系统评价和荟萃分析。
Cefiderocol either in monotherapy or combination versus best available therapy in the treatment of carbapenem-resistant Acinetobacter baumannii infections: A systematic review and meta-analysis.
机构信息
Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, Naples, Italy.
出版信息
J Infect. 2024 Mar;88(3):106113. doi: 10.1016/j.jinf.2024.01.012. Epub 2024 Feb 6.
BACKGROUND
The best treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still a matter of debate.
OBJECTIVES
To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT).
DATA SOURCES
We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023.
STUDY ELIGIBILITY CRITERIA
Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT.
PARTICIPANTS
Patients with infections due to CRAB.
INTERVENTIONS
Cefiderocol in monotherapy or in combination with other potentially active agents or BAT.
ASSESSMENT OF RISK OF BIAS
We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies.
METHODS OF DATA SYNTHESIS
We conducted a meta-analysis pooling risk ratios (RRs) through random effect models.
RESULTS
We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38-47%), the rate of microbiological failure 48% (95% CI 31-65%), the clinical failure rate 43% (95% CI 32-55%), and the rate of ADRs was 3% (95% CI 1-6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43-0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57-0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09-0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate.
CONCLUSIONS
Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections.
背景
对于碳青霉烯类耐药鲍曼不动杆菌（CRAB）感染，最佳治疗方法仍存在争议。
目的
描述头孢地尔治疗 CRAB 感染患者的结局，并比较头孢地尔与最佳可用治疗（BAT）的疗效。
数据来源
我们检索了 MEDLINE、Cochrane 图书馆和 EMBASE，以筛选截至 2023 年 9 月发表的原始报告。
研究入选标准
随机对照试验（RCT）和观察性研究，调查使用头孢地尔或 BAT 治疗的患者的 30 天死亡率、临床失败率、微生物失败率或药物不良反应发生率。
研究对象
感染 CRAB 的患者。
干预措施
头孢地尔单药或联合其他潜在有效药物治疗或 BAT。
偏倚风险评估
我们使用 Cochrane RCT 风险偏倚工具和纽卡斯尔-渥太华量表对观察性研究进行评估。
数据综合方法
我们采用随机效应模型进行荟萃分析，汇总风险比（RR）。
结果
我们筛选了 801 篇原始报告，纳入了 18 项研究（2 项 RCT、13 项队列研究和 3 项病例系列研究），共纳入 733 例接受头孢地尔治疗的患者和 473 例接受 BAT 的患者。接受头孢地尔治疗的患者中，30 天死亡率为 42%（95%CI 38-47%），微生物失败率为 48%（95%CI 31-65%），临床失败率为 43%（95%CI 32-55%），药物不良反应发生率为 3%（95%CI 1-6%）。与联合治疗方案相比，接受头孢地尔单药治疗的患者死亡率较低（RR：0.64；95%CI：0.43-0.94，p=0.024）。我们发现，与 BAT 相比，接受头孢地尔治疗的患者死亡率（RR：0.74；95%CI：0.57-0.95，p=0.02）和药物不良反应发生率（RR：0.28；95%CI：0.09-0.91，p=0.03）显著降低，而微生物和临床失败率无差异。
结论
我们的数据支持头孢地尔在 CRAB 感染中的疗效和安全性。
Zotero 插件