Efficacy of short-course antibiotics for culture-positive neonatal sepsis: A systematic review and meta-analysis.

IF 1.6 4区 医学 Q2 PEDIATRICS
Poonam Singh, Mayank Priyadarshi, Suman Chaurasia, Sriparna Basu
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Abstract

Sepsis is a common cause of neonatal mortality and morbidity. Though antibiotics are the mainstay of treatment in culture-positive neonatal sepsis, the dilemma persists for the optimum duration of antimicrobial therapy. The present study aimed to evaluate the efficacy of short-course antibiotics for uncomplicated culture-positive neonatal sepsis. This systematic review and meta-analysis (PROSPERO: CRD42023444899) identified, appraised, and synthesised the available evidence from randomised and quasi-randomised controlled trials related to the efficacy of short-course (7-10 days) versus standard-course (14 days) antibiotics for uncomplicated culture-positive neonatal sepsis on the rate of treatment failure, mortality, duration of hospitalisation, morbidities including antibiotics-related adverse events, long-term neurodevelopmental outcomes and cost analysis. Data were pooled using RevMan 5.4 software. Certainty of evidence (COE) for predefined outcomes was analysed by GRADE. Available evidence showed no significant difference in the rate of treatment failure between 7- to 10-day versus 14-day antibiotics courses [risk ratio (95% confidence interval, CI), 2.45 (0.93-6.47), I2 = 0%, six studies, n = 573, very low COE]. No incidence of death was reported in either treatment arm in the two included studies. Duration of hospitalisation was significantly shorter with the short-course antibiotics arm compared to standard-course [mean difference (95% CI), -3.88 (-4.22 to -3.54) days, I2 = 0%, five studies, n = 507, low COE]. Morbidities reported in the three studies were similar. Other outcomes were not reported. To conclude the evidence is very uncertain about the effect of short-course antibiotic regimen, compared to a standard-course, on the treatment failure rate in uncomplicated culture-positive neonatal sepsis. Adequately powered trials with outcomes including death and long-term neurodevelopmental impairment are needed.

短程抗生素对培养阳性新生儿败血症的疗效:系统回顾和荟萃分析。
败血症是新生儿死亡和发病的常见原因。虽然抗生素是治疗培养阳性新生儿败血症的主要药物,但抗菌治疗的最佳持续时间却一直是个难题。本研究旨在评估短程抗生素治疗无并发症培养阳性新生儿败血症的疗效。本系统综述和荟萃分析(PROSPERO:CRD42023444899)从随机和准随机对照试验中鉴定、评估和综合了与无并发症培养阳性新生儿败血症短疗程(7-10 天)与标准疗程(14 天)抗生素疗效相关的现有证据,包括治疗失败率、死亡率、住院时间、发病率(包括抗生素相关不良事件)、长期神经发育结果和成本分析。数据使用 RevMan 5.4 软件进行汇总。通过 GRADE 对预定义结果的证据确定性(COE)进行了分析。现有证据显示,7-10 天抗生素疗程与 14 天抗生素疗程的治疗失败率无明显差异[风险比(95% 置信区间,CI),2.45 (0.93-6.47),I2 = 0%,6 项研究,n = 573,极低 COE]。在纳入的两项研究中,两种治疗方法均未报告死亡病例。短程抗生素治疗组的住院时间明显短于标准治疗组[平均差异(95% CI),-3.88(-4.22 至-3.54)天,I2 = 0%,5 项研究,n = 507,低 COE]。三项研究报告的发病率相似。其他结果未见报道。总之,与标准疗程相比,短疗程抗生素方案对无并发症培养阳性新生儿败血症治疗失败率的影响尚不确定。需要进行充分有效的试验,以得出包括死亡和长期神经发育障碍在内的结果。
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来源期刊
CiteScore
2.90
自引率
5.90%
发文量
487
审稿时长
3-6 weeks
期刊介绍: The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.
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