Quan Xiang Hua, Wang Xin Yi, Han Chun Hua, Xing Xiao Min, Zhang Bin, Cang Huai Qin
Department of Pharmacy, Affiliated Hospital of Qingdao University, Qingdao, China.
Department of Clinical Laboratory, Affiliated Hospital of Qingdao University, Qingdao, China.
Front Pharmacol. 2024 Oct 10;15:1420170. doi: 10.3389/fphar.2024.1420170. eCollection 2024.
Novel β-lactam antibiotics as well as other kinds of antibiotics have been used to treat complicated urinary tract infections (cUTIs); however, their efficacy and safety remain controversial.
We conducted a systematic review with meta-analysis to explore the efficacy and safety of novel β-lactam antibiotics versus other antibiotics against cUTIs.
PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched systematically from inception through 15 March 2024 for clinical trials comparing novel β-lactam antibiotics with other antibiotics for treatment of cUTIs. Random-effects models were used to evaluate the impact of treatment on the risk ratio (RR) of clinical response, microbiologic response, adverse effects (AEs), serious adverse effects (SAEs). The quality of evidence was evaluated with the Cochrane Risk of Bias assessment tool. The review was registered in INPLASY (INPLASY202440054).
Ten randomized controlled trials involving 5, 925 patients met our inclusion criteria. Our meta-analysis revealed that there was no significant difference in overall clinical response (RR = 1.02), AEs (RR = 1.07), SAEs (RR = 1.20) between novel β-lactam antibiotics groups and other antibiotics groups. However, a significant difference was found in a subgroup of clinical cure rates at the end of treatment between novel β-lactam antibiotics groups and carbapenems groups, with low heterogeneity (RR = 1.02). A significant difference was observed in microbiologic response (RR = 1.11). Subgroup analysis revealed a significant difference in microbiologic response between novel BBL/BLS groups and carbapenems groups (RR = 1.13, I = 21%, P = 0.005). Differences was observed between novel BBL/BLS groups and piperacillin/tazobactam sodium groups (RR = 1.21, I = 70%, P = 0.02). Similar results were obtained from subgroup analysis of the difference in microbiologic response between novel β-lactam antibiotics groups and ertapenem groups (RR = 0.92, I = 0, P = 0.01).
Novel β-lactam antibiotics had similar overall clinical cure, AEs, SAE, to other antibiotics in the treatment of cUTIs. However, novel β-lactam antibiotics demonstrated superior clinical cure rates compared to carbapenems in a subgroup analysis, and exhibited better microbiologic response than other antibiotics.
新型β-内酰胺类抗生素以及其他种类的抗生素已被用于治疗复杂性尿路感染（cUTIs）；然而，它们的疗效和安全性仍存在争议。
我们进行了一项系统评价和荟萃分析，以探讨新型β-内酰胺类抗生素与其他抗生素治疗cUTIs的疗效和安全性。
从创刊至2024年3月15日，系统检索PubMed、Embase和Cochrane对照试验中央注册库，以查找比较新型β-内酰胺类抗生素与其他抗生素治疗cUTIs的临床试验。采用随机效应模型评估治疗对临床反应、微生物学反应、不良反应（AEs）、严重不良反应（SAEs）风险比（RR）的影响。采用Cochrane偏倚风险评估工具评估证据质量。该评价已在INPLASY注册（INPLASY202440054）。
10项涉及5925例患者的随机对照试验符合我们的纳入标准。我们的荟萃分析显示，新型β-内酰胺类抗生素组与其他抗生素组在总体临床反应（RR = 1.02）、AEs（RR = 1.07）、SAEs（RR = 1.20）方面无显著差异。然而，在治疗结束时的临床治愈率亚组分析中，新型β-内酰胺类抗生素组与碳青霉烯类抗生素组之间存在显著差异，异质性较低（RR = 1.02）。在微生物学反应方面观察到显著差异（RR = 1.11）。亚组分析显示，新型BBL/BLS组与碳青霉烯类抗生素组在微生物学反应方面存在显著差异（RR = 1.13，I = 21%，P = 0.005）。新型BBL/BLS组与哌拉西林/他唑巴坦钠组之间存在差异（RR = 1.21，I = 70%，P = 0.02）。新型β-内酰胺类抗生素组与厄他培南组在微生物学反应差异的亚组分析中也得到了类似结果（RR = 0.92，I = 0，P = 0.01）。
新型β-内酰胺类抗生素在治疗cUTIs时，总体临床治愈率、AEs、SAEs与其他抗生素相似。然而，在亚组分析中，新型β-内酰胺类抗生素的临床治愈率高于碳青霉烯类抗生素，并且在微生物学反应方面比其他抗生素表现更好。
Zotero 插件
