脓毒症重症患者中持续输注与间断输注美罗培南的比较：一项采用序贯试验分析的随机对照试验的系统评价和荟萃分析

Continuous vs. intermittent meropenem infusion in critically ill patients with sepsis: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis.

作者信息

Wang Youquan, Li Yanhua, Gao Meng, Zhang Mingtao, Li Yuting, Wang Dongxia, Li Xinyu, Zhang Chaoyang, Fu Yao, Li Hongxiang, Zhang Dong

机构信息

Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.

Department of Emergency Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.

出版信息

Front Med (Lausanne). 2025 Jun 10;12:1580116. doi: 10.3389/fmed.2025.1580116. eCollection 2025.

BACKGROUND

A recent large multicenter randomized controlled trial (RCT) found that continuous infusion (CI) of meropenem did not improve clinical outcomes in critically ill patients, contradicting previous meta-analysis results.

METHODS

We conducted a search of the PubMed, EMBASE, and Cochrane databases up to March 19, 2024.

RESULTS

Our study included a total of 1,075 critically ill patients with sepsis from five RCTs. The primary outcome indicated that CI of meropenem did not reduce all-cause mortality in patients (RR = 0.89; 95% CI, 0.75-1.04; = 0.15; Chi= 5.75; = 30%). The secondary outcomes revealed that compared to II of meropenem, patients receiving CI had shorter ICU length of stay (MD = -2.39; 95% CI, -2.98 to -1.81; < 0.00001; Chi= 6.63; = 40%), higher clinical cure rates (RR = 1.88; 95% CI, 1.23-2.87; = 0.004; Chi = 1.87; = 0%), and shorter duration of meropenem therapy (MD = -0.86; 95% CI, -1.36 to -0.36; = 0.0008; Chi = 3.65; = 45%).

CONCLUSION

In critically ill patients with sepsis, CI of meropenem did not reduce mortality but was associated with shorter ICU length of stays, higher clinical cure rates, and shorter duration of meropenem therapy. Further large-scale RCTs are needed to validate these findings.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/view/CRD42024528380, identifier CRD42024528380.

背景

最近一项大型多中心随机对照试验（RCT）发现，美罗培南持续输注（CI）并未改善重症患者的临床结局，这与之前的荟萃分析结果相矛盾。

方法

我们检索了截至2024年3月19日的PubMed、EMBASE和Cochrane数据库。

结果

我们的研究共纳入了来自五项随机对照试验的1075例重症脓毒症患者。主要结局表明，美罗培南持续输注并未降低患者的全因死亡率（风险比=0.89；95%置信区间，0.75-1.04；P=0.15；卡方=5.75；自由度=30%）。次要结局显示，与美罗培南间歇输注相比，接受持续输注的患者重症监护病房（ICU）住院时间更短（平均差=-2.39；95%置信区间，-2.98至-1.81；P<0.00001；卡方=6.63；自由度=40%），临床治愈率更高（风险比=1.88；95%置信区间，1.23-2.87；P=0.004；卡方=1.87；自由度=0%），美罗培南治疗疗程更短（平均差=-0.86；95%置信区间，-1.36至-0.36；P=0.0008；卡方=3.65；自由度=45%）。