D'Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A
Mario Negri Institute for Pharmacological Research, 20157 Milan, Italy.
BMJ. 1998 Apr 25;316(7140):1275-85. doi: 10.1136/bmj.316.7140.1275.
To determine whether antibiotic prophylaxis reduces respiratory tract infections and overall mortality in unselected critically ill adult patients.
Meta-analysis of randomised controlled trials from 1984 and 1996 that compared different forms of antibiotic prophylaxis used to reduce respiratory tract infections and mortality with aggregate data and, in a subset of trials, data from individual patients.
Unselected critically ill adult patients; 5727 patients for aggregate data meta-analysis, 4343 for confirmatory meta-analysis with data from individual patients.
Respiratory tract infections and total mortality.
Two categories of eligible trials were defined: topical plus systemic antibiotics versus no treatment and topical preparation with or without a systemic antibiotic versus a systemic agent or placebo. Estimates from aggregate data meta-analysis of 16 trials (3361 patients) that tested combined treatment indicated a strong significant reduction in infection (odds ratio 0.35; 95% confidence interval 0.29 to 0.41) and total mortality (0.80; 0.69 to 0.93). With this treatment five and 23 patients would need to be treated to prevent one infection and one death, respectively. Similar analysis of 17 trials (2366 patients) that tested only topical antibiotics indicated a clear reduction in infection (0.56; 0.46 to 0.68) without a significant effect on total mortality (1.01; 0.84 to 1.22). Analysis of data from individual patients yielded similar results. No significant differences in treatment effect by major subgroups of patients emerged from the analyses.
This meta-analysis of 15 years of clinical research suggests that antibiotic prophylaxis with a combination of topical and systemic drugs can reduce respiratory tract infections and overall mortality in critically ill patients. This effect is significant and worth while, and it should be considered when practice guidelines are defined.
确定抗生素预防性治疗能否降低未筛选的成年危重症患者的呼吸道感染及总体死亡率。
对1984年至1996年的随机对照试验进行荟萃分析，这些试验比较了用于降低呼吸道感染和死亡率的不同形式的抗生素预防性治疗，采用汇总数据，并在部分试验中采用个体患者数据。
未筛选的成年危重症患者；5727例患者用于汇总数据荟萃分析，4343例用于基于个体患者数据的验证性荟萃分析。
呼吸道感染和总死亡率。
确定了两类符合条件的试验：局部加全身用抗生素与不治疗对比，以及含或不含全身用抗生素的局部制剂与全身用药或安慰剂对比。对16项试验（3361例患者）进行的汇总数据荟萃分析估计，联合治疗可显著降低感染率（比值比0.35；95%置信区间0.29至0.41）和总死亡率（0.80；0.69至0.93）。采用这种治疗方法，分别需要治疗5例和23例患者才能预防1例感染和1例死亡。对17项试验（2366例患者）进行的类似分析仅测试了局部用抗生素，结果显示感染率明显降低（0.56；0.46至0.68），但对总死亡率无显著影响（1.01；0.84至1.22）。个体患者数据分析得出了类似结果。分析未发现患者主要亚组在治疗效果上有显著差异。
这项对15年临床研究的荟萃分析表明，局部和全身联合使用抗生素进行预防性治疗可降低危重症患者的呼吸道感染和总体死亡率。这种效果显著且值得，在制定实践指南时应予以考虑。
