A systematic review and meta-analysis on the efficacy of carbapenems versus metronidazole combination therapy in patients infected with Bacteroides spp.

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2025-03-26 DOI:10.1016/j.jiac.2025.102687

Hideo Kato , Jun Hirai , Tomonori Takano , Yu Arakawa , Yuka Yamagishi , Hiroyuki Kunishima , Hiroshige Mikamo

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引用次数: 0

Abstract

Background

Bacteroides spp. are frequently detected in anaerobic infections, with a mortality rate of 50 % attributed to inadequate antimicrobial therapy. Recently, Bacteroides spp. have shown increased resistance to metronidazole (MNZ) and carbapenems. Therefore, identifying appropriate drugs for treating infections caused by Bacteroides spp. is necessary. Hence, this meta-analysis aimed to compare the clinical efficacy of combination therapy with MNZ versus carbapenems for the treatment of infections due to Bacteroides spp.

Methods

Scopus, EMBASE, PubMed, CINAHL, and Ichushi databases were searched for relevant articles that met the inclusion criteria through October 2024. Clinical efficacy was defined as the percentage of patients who achieved complete resolution or remarkable improvement in all signs and symptoms of the infection; therefore, no additional antibiotics or procedures were necessary, and the percentage of eradication of Bacteroides spp.

Results

Of the 482 citations identified for screening, five studies with a total of 306 patients were enrolled. All included studies were randomized clinical trials, two were open-label studies, and three were double-blind studies. All the included patients had intra-abdominal infections (IAIs). The combined therapy with MNZ was comparable with the carbapenem group in clinical efficacy in the treatment of infections due to Bacteroides spp. (risk rate 1.03, 95 % confidence interval 0.93–1.14).

Conclusions

Combined therapy with MNZ could be an effective treatment option for infections caused by Bacteroides spp., similar to carbapenems.

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碳青霉烯类与甲硝唑联合治疗拟杆菌感染疗效的系统回顾和荟萃分析。

在厌氧感染中经常检测到拟杆菌，由于抗菌治疗不充分，死亡率为50%。近年来，拟杆菌类对甲硝唑（MNZ）和碳青霉烯类的耐药性增强。因此，确定适当的药物来治疗由拟杆菌引起的感染是必要的。因此，本荟萃分析旨在比较MNZ与碳青霉烯类药物联合治疗拟杆菌感染的临床疗效。方法检索scopus、EMBASE、PubMed、CINAHL和Ichushi数据库，检索截至2024年10月符合纳入标准的相关文章。临床疗效定义为感染的所有体征和症状完全缓解或显著改善的患者百分比；因此，不需要额外的抗生素或手术，根除拟杆菌的百分比。结果在筛选确定的482例引用中，5项研究共纳入了306例患者。所有纳入的研究均为随机临床试验，2项为开放标签研究，3项为双盲研究。所有患者均有腹腔感染（IAIs）。联合MNZ治疗拟杆菌感染的临床疗效与碳青霉烯组相当（危险率1.03,95%可信区间0.93-1.14）。结论与碳青霉烯类药物类似，MNZ联合治疗拟杆菌属感染是一种有效的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.