重症社区获得性肺炎初始经验性抗生素治疗方案的比较：一项网状Meta分析。

Comparison of initial empirical antibiotic regimens in severe community-acquired pneumonia: a network meta-analysis.

作者信息

Wang Min, Zhang Jing, Wang Xiaoming, Wang Qian, Wang Lian, Zhuang Han, Liu Ao

机构信息

Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang, 471003, China.

Department of Respiratory Medicine, Chengdu BOE Hospital, Chengdu, Sichuan Province, 610000, China.

出版信息

BMC Pulm Med. 2025 May 20;25(1):246. doi: 10.1186/s12890-025-03695-w.

DOI:10.1186/s12890-025-03695-w

PMID:40394546

Abstract

BACKGROUND

Severe community-acquired pneumonia (SCAP) remains a leading cause of morbidity and mortality worldwide. Identifying the optimal antibiotic regimen for treating SCAP is crucial for improving patient outcomes.

METHODS

We searched the PubMed, Embase, and Cochrane Central Register of Controlled Clinical Trials databases to identify studies reporting initial empirical antibiotic regimens in patients with SCAP. We performed a network meta-analysis to compare the relative efficacy of different antibiotic regimens in treating SCAP. The primary outcome was overall mortality. The second outcomes were 30-day mortality and in-hospital mortality.

RESULTS

This network meta-analysis included 1 randomized clinical trial and 13 observational studies with 8142 patients, categorized into five treatment groups: β-lactam antibiotics, β-lactam antibiotics plus doxycycline, β-lactam antibiotics plus fluoroquinolones, β-lactam antibiotics plus macrolides, and fluoroquinolones monotherapy. β-lactam antibiotics plus macrolides was ranked as the most effective treatment (surface under the cumulative ranking curve, 92.0%; mean rank, 1.3). The β-lactam antibiotics plus macrolides combination significantly reduced overall mortality compared to β-lactam antibiotics alone (RR, 0.79; 95% CI, 0.64-0.96) and β-lactam antibiotics plus fluoroquinolones (RR, 0.67; 95% CI, 0.64-0.82).

CONCLUSION

Our findings suggest that β-lactam antibiotics plus macrolides may be the optimal treatment for SCAP. β-lactam antibiotics monotherapy and β-lactam antibiotics plus fluoroquinolones should not be recommended due to their inferior outcomes.

摘要

背景

重症社区获得性肺炎（SCAP）仍是全球发病和死亡的主要原因。确定治疗SCAP的最佳抗生素方案对于改善患者预后至关重要。

方法

我们检索了PubMed、Embase和Cochrane临床对照试验中央注册数据库，以识别报告SCAP患者初始经验性抗生素方案的研究。我们进行了网络荟萃分析，以比较不同抗生素方案治疗SCAP的相对疗效。主要结局是总体死亡率。次要结局是30天死亡率和住院死亡率。

结果

该网络荟萃分析纳入了1项随机临床试验和13项观察性研究，共8142例患者，分为五个治疗组：β-内酰胺类抗生素、β-内酰胺类抗生素加强力霉素、β-内酰胺类抗生素加氟喹诺酮类、β-内酰胺类抗生素加大环内酯类以及氟喹诺酮类单药治疗。β-内酰胺类抗生素加大环内酯类被列为最有效的治疗方法（累积排序曲线下面积，92.0%；平均秩次，1.3）。与单独使用β-内酰胺类抗生素（RR，0.79；95%CI，0.64 - 0.96）和β-内酰胺类抗生素加氟喹诺酮类（RR，0.67；95%CI，0.64 - 0.82）相比，β-内酰胺类抗生素加大环内酯类联合用药显著降低了总体死亡率。