Department of Infectious Diseases, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Xiangshan First People's Hospital Medical and Health Group, Ningbo Fourth Hospital, Ningbo, China.
Department of Infectious Diseases, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Xiangshan First People's Hospital Medical and Health Group, Ningbo Fourth Hospital, Ningbo, China.
Pulm Pharmacol Ther. 2024 Sep;86:102315. doi: 10.1016/j.pupt.2024.102315. Epub 2024 Jul 14.
The aim of this study was to evaluate the efficacy and safety of inhaled antibiotics for adults with pneumonia by meta-analysis.
Literature retrieval was completed through five databases (PubMed, Embase, Cochrane Library, Web of Science and Scopus) by the deadline of May 31, 2024. The process of study selection and data extraction were performed independently by two reviewers. The quality of observational studies and randomized controlled trial (RCT) studies were evaluated by Newcastle Ottawa scale and Jadad scale, respectively. The primary outcomes included mortality, clinical cure, and microbiological cure. Secondary outcomes were recurrence and renal impairment.
There were 30 studies were analyzed, including 12 RCT studies and 18 observational studies. Inhaled antibiotics did not significantly reduce mortality in RCT studies (odds ratio (OR) = 1.06, 95 % confidence interval (CI): 0.80-1.41). Inhaled antibiotics were associated with higher rates of clinical cure (OR = 1.47 95%CI: 0.82-2.66 in RCT studies and OR = 2.09, 95%CI: 1.36-3.21 in observational studies) and microbiological cure (OR = 7.00 in RCT studies and OR = 2.20 in observational studies). Subgroup analysis showed patients received inhaled antibiotics combined with intravenous administration and inhaled amikacin had better improvements of mortality, clinical cure and microbiological cure. Inhaled antibiotics were not associated with recurrence. The pooled OR of renal impairment were 0.65 (95%CI: 0.27-1.13; I-squared = 43.5 %, P = 0.124) and 0.63(95%CI: 0.26-1.11; I-squared = 69.0 %, P = 0.110) in RCT studies and observational studies, respectively.
Inhaled antibiotics decreased risk of renal impairment and achieved significant improvements of clinical and microbiological cure in patients with pneumoniae.
本研究旨在通过荟萃分析评估吸入抗生素治疗成人肺炎的疗效和安全性。
截至 2024 年 5 月 31 日，通过五个数据库（PubMed、Embase、Cochrane Library、Web of Science 和 Scopus）进行文献检索。由两名评审员独立完成研究选择和数据提取过程。通过纽卡斯尔-渥太华量表和 Jadad 量表评估观察性研究和随机对照试验 (RCT) 的质量。主要结局包括死亡率、临床治愈率和微生物学治愈率。次要结局包括复发和肾功能损害。
共分析了 30 项研究，包括 12 项 RCT 研究和 18 项观察性研究。吸入抗生素在 RCT 研究中并未显著降低死亡率（比值比 (OR) = 1.06，95%置信区间 [CI]：0.80-1.41）。吸入抗生素与更高的临床治愈率相关（RCT 研究中 OR = 1.47，95%CI：0.82-2.66；观察性研究中 OR = 2.09，95%CI：1.36-3.21）和微生物学治愈率（RCT 研究中 OR = 7.00；观察性研究中 OR = 2.20）。亚组分析显示，接受吸入抗生素联合静脉给药和吸入阿米卡星的患者死亡率、临床治愈率和微生物学治愈率均有改善。吸入抗生素与复发无关。RCT 研究和观察性研究中肾功能损害的合并 OR 分别为 0.65（95%CI：0.27-1.13；I-squared = 43.5%，P = 0.124）和 0.63（95%CI：0.26-1.11；I-squared = 69.0%，P = 0.110）。
吸入抗生素可降低肾功能损害风险，并显著提高肺炎患者的临床和微生物学治愈率。
