Knudsen Maja Johanne Søndergaard, Rubin Ingrid Maria Cecilia, Petersen Andreas Munk
Department of Clinical Microbiology, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark.
Gastrounit, Medical Section, Copenhagen University Hospital-Amager and Hvidovre, 2650 Hvidovre, Denmark.
Antibiotics (Basel). 2024 Aug 9;13(8):747. doi: 10.3390/antibiotics13080747.
The aim of this systematic review was to investigate the effect of antibiotics on the eradication of multidrug-resistant organisms (MRO) in intestinal carriers. We defined multidrug-resistant organisms as vancomycin-resistant (VREfm), and multidrug-resistant Gram-negative Methods: We searched the EMBASE, Cochrane Central, and PubMed databases from inception to medio November 2023. We included randomised and controlled clinical trials (RCTs), that investigated the effect of antibiotics on the eradication of multidrug-resistant organisms in intestinal carriers. Finally, we performed a meta-analysis.
We included five RTCs in the systematic review. In four studies an effect of antibiotics on the eradication of MRO was shown at the end of intervention, but it was not sustained at follow-up. In the fifth study, the effect at the end of intervention was not reported, and there was no observed effect of the intervention at follow-up. We included four studies in the meta-analysis, and it suggests an effect of antibiotics on the eradication of MRO in intestinal carriers at the end of follow-up with a -value of 0.04 (95% confidence interval 1.02-1.95). None of the studies reported a significant increase in resistance to the study drug. Gastrointestinal disorders were the most frequent non-severe adverse event.
The effect of antibiotics on the eradication of multidrug-resistant organisms in intestinal carriers was not statistically significant in any of the five included studies; however, we found a significant effect in the pooled meta-analysis. As the confidence interval is large, we cannot determine the clinical importance of this finding, and it should be further investigated.
本系统评价旨在研究抗生素对肠道携带者中多重耐药菌（MRO）根除的影响。我们将多重耐药菌定义为耐万古霉素肠球菌（VREfm）和多重耐药革兰阴性菌。方法：我们检索了EMBASE、Cochrane中心和PubMed数据库，检索时间从数据库建立至2023年11月中旬。我们纳入了调查抗生素对肠道携带者中多重耐药菌根除影响的随机对照临床试验（RCT）。最后，我们进行了荟萃分析。
我们在系统评价中纳入了5项RTC。在4项研究中，干预结束时显示抗生素对多重耐药菌的根除有效果，但在随访时未持续。在第5项研究中，未报告干预结束时的效果，随访时也未观察到干预效果。我们在荟萃分析中纳入了4项研究，结果表明随访结束时抗生素对肠道携带者中多重耐药菌的根除有效果，P值为0.04（95%置信区间1.02 - 1.95）。没有研究报告对研究药物的耐药性显著增加。胃肠道疾病是最常见的非严重不良事件。
在纳入的5项研究中，没有一项研究显示抗生素对肠道携带者中多重耐药菌的根除效果具有统计学意义；然而，我们在汇总的荟萃分析中发现了显著效果。由于置信区间较大，我们无法确定这一发现的临床重要性，应进一步研究。
