Evaluating the clinical effectiveness of new beta-lactam/beta-lactamase inhibitor combination antibiotics: A systematic literature review and meta-analysis.
Evaluating the clinical effectiveness of new beta-lactam/beta-lactamase inhibitor combination antibiotics: A systematic literature review and meta-analysis.
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DOI：
10.1017/ash.2021.217
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Evans, Charlesnika T
中科院分区：
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作者：
Wilson, Geneva M;Fitzpatrick, Margaret A;Walding, Kyle;Gonzalez, Beverly;Schweizer, Marin L;Suda, Katie J;Evans, Charlesnika T
头孢他啶/阿维巴坦(C/A)、头孢洛赞/他唑巴坦(C/T)、亚胺培南/瑞巴坦(I/R)和美罗培南/万宝巴坦(M/V)将头孢菌素(C/T和C/A)或碳青霉烯类抗生素(M/V和I/R)与β-内酰胺酶抑制剂结合。它们用于治疗耐碳青霉烯类肠杆菌(CRE)和/或耐多药铜绿假单胞菌(MDRPA)。我们将这些药物的联合临床成功与较旧的疗法进行了比较。计算机检索PubMed和EMBASE，检索期为2012年1月1日至2020年9月2日，检索词为C/A、C/T、I/R和M/V研究。主要结果是临床成功，使用随机效应模型进行评估。对研究药物、样本大小、质量、感染源、研究设计和多重耐药革兰氏阴性菌(MDRGNO)种群进行了分层分析。微生物学的成功和28天和30天的死亡率被评估为次要结果。使用I2值来确定异质性。总体而言，25篇文章符合纳入标准；8篇观察性研究和17项随机对照试验。对于所有纳入的微生物，我们在比较新的联合抗生素和标准疗法的临床成功率方面没有发现差异(合并OR，1.21；95%CI，0.96-1.51)。我们在纳入的研究中检测到中等水平的异质性，I2=56%。对CRE或MDRPA感染患者的研究表明，使用新的联合抗生素治疗与临床成功之间有很强的相关性(合并OR，2.20；95%CI，1.60-3.57)。C/T、C/A、I/R和M/V在治疗各种复杂感染时并不逊色于标准疗法，但它们在治疗MDRPA和Cre感染方面可能有更大的临床成功。需要更多的研究来评估这些抗生素对耐药感染的使用，以确定它们的有效性。
Ceftazidime/avibactam (C/A), ceftolozane/tazobactam (C/T), imipenem/relebactam (I/R), and meropenem/vaborbactam (M/V) combine either a cephalosporin (C/T and C/A) or a carbapenem antibiotic (M/V and I/R) with a β-lactamase inhibitor. They are used to treat carbapenem-resistant Enterobacterales (CRE) and/or multidrug-resistant Pseudomonas aeruginosa (MDRPA). We compared the pooled clinical success of these medications to older therapies. PubMed and EMBASE were searched from January 1, 2012, through September 2, 2020, for C/A, C/T, I/R, and M/V studies. The main outcome was clinical success, which was assessed using random-effects models. Stratified analyses were conducted for study drug, sample size, quality, infection source, study design, and multidrug-resistant gram-negative organism (MDRGNO) population. Microbiological success and 28- and 30-day mortality were assessed as secondary outcomes. Heterogeneity was determined using I2 values. Overall, 25 articles met the inclusion criteria; 8 observational studies and 17 randomized control trials. We detected no difference in clinical success comparing new combination antibiotics with standard therapies for all included organisms (pooled OR, 1.21; 95% CI, 0.96–1.51). We detected a moderate level of heterogeneity among the included studies I2 = 56%. Studies that focused on patients with CRE or MDRPA infections demonstrated a strong association between treatment with new combination antibiotics and clinical success (pooled OR, 2.20; 95% CI, 1.60–3.57). C/T, C/A, I/R, and M/V are not inferior to standard therapies for treating various complicated infections, but they may have greater clinical success for treating MDRPA and CRE infections. More studies that evaluate the use of these antibiotics for drug-resistant infections are needed to determine their effectiveness.