A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: A meta-analytic/meta-regression study
A survival benefit of combination antibiotic therapy for serious infections associated with sepsis and septic shock is contingent only on the risk of death: A meta-analytic/meta-regression study
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DOI：
10.1097/ccm.0b013e3181e96b91
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发表时间：
2010-08-01
影响因子：
8.8
通讯作者：
Chateau, Dan
中科院分区：
文献类型：
--
作者：
Kumar, Anand;Safdar, Nasia;Chateau, Dan
目的：评估联合抗生素治疗的潜在获益是否仅限于最危重的患者亚群，尤其是感染性休克患者。数据来源：奥维德MEDLINE（1950- 2009年10月）、EMBASE（1980- 2009年10月）、科克伦对照试验中心注册（至2009年第三季度）、ClinicalTrial.gov数据库和SCOPUS数据库。研究选择：可能与脓毒症或脓毒性休克相关的严重细菌感染的抗菌治疗的随机或观察性研究。数据提取：研究设计、死亡率/临床反应和其他变量由两名评价者独立提取。在可能的情况下，研究数据集被分成有和没有休克或危重病的互斥组。数据综合：尽管合并的比值比表明联合治疗没有总体死亡率/临床应答获益（比值比，0.856; 95%置信区间，0.71-1.03; p = 0.0943; I-2 = 45.1%），根据单药治疗死亡风险对数据集进行分层，结果显示，在最严重的疾病亚组中，（单药治疗死亡风险>25%;死亡优势比，0.51; 95%置信区间，0.41-0.64; I-2 = 8.6%）。在那些可以根据休克/危重病的存在进行分层的数据集中，病情更严重的组始终显示出联合治疗策略的疗效增加（比值比，0.49; 95%置信区间，0.35-0.70; p <0.0001; I-2 = 0%）。低风险患者的死亡风险增加（死亡风险
Objective: To assess whether a potential benefit with combination antibiotic therapy is restricted to the most critically ill subset of patients, particularly those with septic shock.Data Sources: OVID MEDLINE (1950-October 2009), EMBASE (1980-October 2009), the Cochrane Central Register of Controlled Trials (to third quarter 2009), the ClinicalTrial.gov database, and the SCOPUS database.Study Selection: Randomized or observational studies of antimicrobial therapy of serious bacterial infections potentially associated with sepsis or septic shock. Fifty studies met entry criteria.Data Extraction: Study design, mortality/clinical response, and other variables were extracted independently by two reviewers. When possible, study datasets were split into mutually exclusive groups with and without shock or critical illness.Data Synthesis: Although a pooled odds ratio indicated no overall mortality/clinical response benefit with combination therapy (odds ratio, 0.856; 95% confidence interval, 0.71-1.03; p = .0943; I-2 = 45.1%), stratification of datasets by monotherapy mortality risk demonstrated substantial benefit in the most severely ill subset (monotherapy risk of death >25%; odds ratio of death, 0.51; 95% confidence interval, 0.41-0.64; I-2 = 8.6%). Of those datasets that could be stratified by the presence of shock/critical illness, the more severely ill group consistently demonstrated increased efficacy of a combination therapy strategy (odds ratio, 0.49; 95% confidence interval, 0.35-0.70; p < .0001; I-2 = 0%). An increased risk of death was found in low-risk patients (risk of death