Choosing Optimal Antibiotics for the Treatment of Patients Infected With Enterobacteriaceae: A Network Meta-analysis and Cost-Effectiveness Analysis.
Choosing Optimal Antibiotics for the Treatment of Patients Infected With Enterobacteriaceae: A Network Meta-analysis and Cost-Effectiveness Analysis.
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选择最佳抗生素治疗肠杆菌科感染患者：网络荟萃分析和成本效益分析
DOI：
10.3389/fphar.2021.656790
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发表时间：
2021
影响因子：
5.6
通讯作者：
Wang Y
中科院分区：
文献类型：
--
作者：
Han R;Teng M;Zhang Y;Zhang T;Wang T;Chen J;Li S;Yang B;Shi Y;Dong Y;Wang Y
碳青霉烯类药物的过度使用导致越来越多的碳青霉烯类肠杆菌耐药。其他抗生素[特别是新型β-内酰胺/β-内酰胺酶抑制剂组合（BL/BLIs）]治疗肠杆菌科是否优于碳青霉烯类抗生素，目前尚不清楚。我们进行了系统的文献检索，以确定评估抗生素对肠杆菌科感染的疗效和安全性的随机对照试验（rct）。我们进行了传统的配对荟萃分析来比较头孢他啶/阿维巴坦与比较物。网络荟萃分析（NMA）用于整合所有干预措施的直接和间接证据。此外，采用联合决策分析马尔可夫模型对复杂尿路感染（cUTI）患者的治疗进行成本-效果分析。共确定了25项相关的随机对照试验，包括15种不同的干预措施。配对荟萃分析显示，头孢他啶/阿维巴坦的疗效和安全性与比较物（碳青霉烯类）相当。在NMA中，累积排序曲线概率下的表面显示，在疗效方面，排名最高的干预措施为美罗培南/瓦波巴坦、美罗培南、亚胺培南/西司他汀、头孢曲松、头孢他啶/阿维巴坦和头孢甲苯/他唑巴坦[但两种抗生素之间无显著差异（p < 0.05）]。在安全性方面，头孢他啶/阿维巴坦的不良事件发生率高于哌拉西林/他唑巴坦（相对危险度= 0.74,95%可信区间= 0.59-0.94）。基于中国的药物和住院费用，与亚胺培南/西司他汀相比，美罗培南、头孢他啶/阿维巴坦和头孢唑烷/他唑巴坦在cui患者中每质量调整生命年获得的增量成本-效果比分别为579美元、24569美元和29040美元。这些BL/ bli作为碳青霉烯类替代品的作用需要大规模和高质量的研究来验证。
Overuse of carbapenems has led to the increasing carbapenem-resistant Enterobacteriaceae. It is still unknown whether other antibiotics [especially novel β-lactam/β-lactamase inhibitor combinations (BL/BLIs)] are better than carbapenems in the treatment of Enterobacteriaceae. A systematic literature search was performed to identify randomized controlled trials (RCTs) assessing the efficacy and safety of any antibiotics on Enterobacteriaceae infections. We carried out a traditional paired meta-analysis to compare ceftazidime/avibactam to comparators. Network meta-analysis (NMA) was conducted to integrate direct and indirect evidence of all interventions. Moreover, cost-effectiveness analysis using a combined decision analytical Markov model was completed for the treatment of patients with complex urinary tract infection (cUTI). A total of 25 relevant RCTs were identified, comprising 15 different interventions. Ceftazidime/avibactam exhibited comparable efficacy and safety with comparators (carbapenems) in the paired meta-analysis. In the NMA, the surface under the cumulative ranking curve probabilities showed that in terms of efficacy, the interventions with the highest-ranking were meropenem/vaborbactam, meropenem, imipenem/cilastatin, ceftriaxone, ceftazidime/avibactam, and ceftolozane/tazobactam [but no significant difference between any two antibiotics (p > 0.05)]. Regarding safety, ceftazidime/avibactam had a higher incidence of adverse events than that of piperacillin/tazobactam (relative risk = 0.74, 95% confidence interval = 0.59–0.94). Based on drug and hospitalization costs in China, the incremental cost-effectiveness ratio per quality-adjusted life-year gained in the patients with cUTI for meropenem, ceftazidime/avibactam, and ceftolozane/tazobactam compared to imipenem/cilastatin were US$579, US$24569, and US$29040, respectively. The role of these BL/BLIs to serve as alternatives to carbapenems requires large-scale and high-quality studies to validate.
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DOI：
10.1093/cid/ciw133
发表时间：
2016-06-01
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Mazuski JE;Gasink LB;Armstrong J;Broadhurst H;Stone GG;Rank D;Llorens L;Newell P;Pachl J
通讯作者：
Pachl J
影响因子：
11.8
作者：
Kaye, Keith S.;Rice, Louis B.;Ellis-Grosse, Evelyn J.
通讯作者：
Ellis-Grosse, Evelyn J.
影响因子：
5.5
作者：
Naylor NR;Atun R;Zhu N;Kulasabanathan K;Silva S;Chatterjee A;Knight GM;Robotham JV
通讯作者：
Robotham JV
影响因子：
3.2
作者：
Merdjan, Henri;Rangaraju, Manickam;Tarral, Antoine
通讯作者：
Tarral, Antoine
影响因子：
1.8
作者：
Fomin, P.;Koalov, S.;Tellado, J.
通讯作者：
Tellado, J.