Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review.
Oral Is the New IV. Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review.
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口头是新的IV。挑战性的几十年血液和骨骼感染教条：系统评价。
DOI：
10.1016/j.amjmed.2021.10.007
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Spellberg B
中科院分区：
文献类型：
--
作者：
Wald-Dickler N;Holtom PD;Phillips MC;Centor RM;Lee RA;Baden R;Spellberg B
我们试图确定对照的前瞻性临床数据是否证实了长期以来的信念，即静脉（IV）抗生素治疗是三种侵袭性细菌感染（骨髓炎，菌血症和感染性心内膜炎）治疗的全部持续时间。我们对已发表的前瞻性对照试验进行了系统回顾，这些试验比较了静脉给药与口服降压方案治疗这些疾病的效果。使用PubMed数据库，我们确定了7项骨髓炎相关随机对照试验（RCT），9项菌血症相关随机对照试验（RCT），1项包括骨髓炎和菌血症，3项心内膜炎相关随机对照试验（RCT），以及1项准实验性心内膜炎研究。分别使用RevMan 5.4.1和Meta-Essentials免费软件，通过森林图和漏斗图（研究偏倚风险）合成研究结果。21项研究证明口服与仅静脉注射抗菌药物治疗的临床疗效无差异或优效性（包括死亡率）;无研究证明仅静脉注射治疗的疗效上级。导管相关不良事件的频率和住院时间在仅静脉组中均更高。许多前瞻性对照研究表明，口服抗生素至少与静脉注射治疗一样有效、安全，并且住院时间更短;没有发现相反的数据。应修改治疗指南，以表明口服治疗适用于合理选择的骨髓炎、菌血症和心内膜炎患者。
We sought to determine if controlled, prospective clinical data validate the long-standing belief that intravenous (IV) antibiotic therapy is required for the full duration of treatment for three invasive bacterial infections: osteomyelitis, bacteremia, and infective endocarditis. We performed a systematic review of published, prospective, controlled trials that compared IV-only to oral stepdown regimens in the treatment of these diseases. Using the PubMed database, we identified 7 relevant randomized controlled trials (RCTs) of osteomyelitis, 9 of bacteremia, 1 including both osteomyelitis and bacteremia, and 3 of endocarditis, as well as one quasi-experimental endocarditis study. Study results were synthesized via forest plots and funnel charts (for risk of study bias), using RevMan 5.4.1 and Meta-Essentials freeware, respectively. The 21 studies demonstrated either no difference in clinical efficacy, or superiority of oral vs. IV-only antimicrobial therapy, including for mortality; in no study was IV-only treatment superior in efficacy. The frequency of catheter-related adverse events and duration of inpatient hospitalization were both greater in IV-only groups. Numerous prospective, controlled investigations demonstrate that oral antibiotics are at least as effective, safer, and lead to shorter hospitalizations than IV-only therapy; no contrary data were identified. Treatment guidelines should be modified to indicate that oral therapy is appropriate for reasonably selected patients with osteomyelitis, bacteremia, and endocarditis.
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影响因子：
3.6
作者：
Frank, AL;Marcinak, JF;Quinn, JP
通讯作者：
Quinn, JP
影响因子：
11.8
作者：
Gariani, Karim;Truong-Thanh Pham;Uckay, Ilker
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Uckay, Ilker
影响因子：
4.9
作者：
GENTRY, LO;RODRIGUEZ, GG
通讯作者：
RODRIGUEZ, GG
影响因子：
5.2
作者：
Geddes, A;Thaler, M;Nowotny, I
通讯作者：
Nowotny, I
影响因子：
5.9
作者：
FASS, RJ;PLOUFFE, JF;RUSSELL, JA
通讯作者：
RUSSELL, JA