{"title":"哌拉西林-他唑巴坦与碳青霉烯类药物对产 ESBL 肠杆菌血流感染住院患者的治疗效果对比：系统综述和荟萃分析。","authors":"Milo Gatti , Pier Giorgio Cojutti , Federico Pea","doi":"10.1016/j.jgar.2024.08.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>To meta-analyse the clinical efficacy of piperacillin-tazobactam vs. carbapenems for treating hospitalized patients affected by extended-spectrum beta-lactamase (ESBL)-producing <em>Enterobacterales</em> bloodstream infections (BSIs).</p></div><div><h3>Methods</h3><p>Two authors independently searched PubMed-MEDLINE and Scopus database up to January 17, 2024, to retrieve randomized controlled trials (RCTs) or observational studies comparing piperacillin-tazobactam vs. carbapenems for the management of hospitalized patients with ESBL-BSIs. Data were independently extracted by the two authors, and the quality of included studies was independently assessed according to ROB 2.0 or ROBINS-I tools. Mortality rate was selected as primary outcome. Meta-analysis was performed by pooling odds ratios (ORs) retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method.</p></div><div><h3>Results</h3><p>After screening 3,418 articles, 10 studies were meta-analysed (one RCT and nine retrospective observational studies; <em>N</em> = 1,962). Mortality rate did not significantly differ between treatment with piperacillin-tazobactam vs. carbapenems (<em>N</em> = 6; OR: 1.41; 95% CI: 0.96–2.07; <em>I²</em> = 23.6%). The findings were consistent also in subgroup analyses assessing patients receiving empirical therapy (<em>N</em> = 5; OR: 1.36; 95% CI: 0.99–1.85), or patients having in ≥50% of cases urinary/biliary tract as the primary BSI source (<em>N</em> = 2; OR: 1.26; 95% CI: 0.84–1.89). Conversely, the mortality rate was significantly higher with piperacillin-tazobactam only among patients having in <50% of cases urinary/biliary tract as the primary source of BSI (<em>N</em> = 3; OR: 2.02; 95% CI: 1.00–4.07).</p></div><div><h3>Conclusions</h3><p>This meta-analysis showed that, after performing appropriate adjustments for confounders, mortality and clinical outcome in patients having ESBL-producing <em>Enterobacterales</em> BSIs did not significantly differ among those receiving piperacillin-tazobactam compared to those receiving carbapenems.</p></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"39 ","pages":"Pages 27-36"},"PeriodicalIF":3.7000,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213716524001541/pdfft?md5=fd450d86ac78baada6b4769dda3b2b3e&pid=1-s2.0-S2213716524001541-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Piperacillin-tazobactam vs. carbapenems for treating hospitalized patients with ESBL-producing Enterobacterales bloodstream infections: A systematic review and meta-analysis\",\"authors\":\"Milo Gatti , Pier Giorgio Cojutti , Federico Pea\",\"doi\":\"10.1016/j.jgar.2024.08.002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>To meta-analyse the clinical efficacy of piperacillin-tazobactam vs. carbapenems for treating hospitalized patients affected by extended-spectrum beta-lactamase (ESBL)-producing <em>Enterobacterales</em> bloodstream infections (BSIs).</p></div><div><h3>Methods</h3><p>Two authors independently searched PubMed-MEDLINE and Scopus database up to January 17, 2024, to retrieve randomized controlled trials (RCTs) or observational studies comparing piperacillin-tazobactam vs. carbapenems for the management of hospitalized patients with ESBL-BSIs. Data were independently extracted by the two authors, and the quality of included studies was independently assessed according to ROB 2.0 or ROBINS-I tools. Mortality rate was selected as primary outcome. Meta-analysis was performed by pooling odds ratios (ORs) retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method.</p></div><div><h3>Results</h3><p>After screening 3,418 articles, 10 studies were meta-analysed (one RCT and nine retrospective observational studies; <em>N</em> = 1,962). Mortality rate did not significantly differ between treatment with piperacillin-tazobactam vs. carbapenems (<em>N</em> = 6; OR: 1.41; 95% CI: 0.96–2.07; <em>I²</em> = 23.6%). The findings were consistent also in subgroup analyses assessing patients receiving empirical therapy (<em>N</em> = 5; OR: 1.36; 95% CI: 0.99–1.85), or patients having in ≥50% of cases urinary/biliary tract as the primary BSI source (<em>N</em> = 2; OR: 1.26; 95% CI: 0.84–1.89). Conversely, the mortality rate was significantly higher with piperacillin-tazobactam only among patients having in <50% of cases urinary/biliary tract as the primary source of BSI (<em>N</em> = 3; OR: 2.02; 95% CI: 1.00–4.07).</p></div><div><h3>Conclusions</h3><p>This meta-analysis showed that, after performing appropriate adjustments for confounders, mortality and clinical outcome in patients having ESBL-producing <em>Enterobacterales</em> BSIs did not significantly differ among those receiving piperacillin-tazobactam compared to those receiving carbapenems.</p></div>\",\"PeriodicalId\":15936,\"journal\":{\"name\":\"Journal of global antimicrobial resistance\",\"volume\":\"39 \",\"pages\":\"Pages 27-36\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-08-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2213716524001541/pdfft?md5=fd450d86ac78baada6b4769dda3b2b3e&pid=1-s2.0-S2213716524001541-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of global antimicrobial resistance\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213716524001541\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of global antimicrobial resistance","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213716524001541","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Piperacillin-tazobactam vs. carbapenems for treating hospitalized patients with ESBL-producing Enterobacterales bloodstream infections: A systematic review and meta-analysis
Objectives
To meta-analyse the clinical efficacy of piperacillin-tazobactam vs. carbapenems for treating hospitalized patients affected by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales bloodstream infections (BSIs).
Methods
Two authors independently searched PubMed-MEDLINE and Scopus database up to January 17, 2024, to retrieve randomized controlled trials (RCTs) or observational studies comparing piperacillin-tazobactam vs. carbapenems for the management of hospitalized patients with ESBL-BSIs. Data were independently extracted by the two authors, and the quality of included studies was independently assessed according to ROB 2.0 or ROBINS-I tools. Mortality rate was selected as primary outcome. Meta-analysis was performed by pooling odds ratios (ORs) retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method.
Results
After screening 3,418 articles, 10 studies were meta-analysed (one RCT and nine retrospective observational studies; N = 1,962). Mortality rate did not significantly differ between treatment with piperacillin-tazobactam vs. carbapenems (N = 6; OR: 1.41; 95% CI: 0.96–2.07; I² = 23.6%). The findings were consistent also in subgroup analyses assessing patients receiving empirical therapy (N = 5; OR: 1.36; 95% CI: 0.99–1.85), or patients having in ≥50% of cases urinary/biliary tract as the primary BSI source (N = 2; OR: 1.26; 95% CI: 0.84–1.89). Conversely, the mortality rate was significantly higher with piperacillin-tazobactam only among patients having in <50% of cases urinary/biliary tract as the primary source of BSI (N = 3; OR: 2.02; 95% CI: 1.00–4.07).
Conclusions
This meta-analysis showed that, after performing appropriate adjustments for confounders, mortality and clinical outcome in patients having ESBL-producing Enterobacterales BSIs did not significantly differ among those receiving piperacillin-tazobactam compared to those receiving carbapenems.
期刊介绍：
The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes.
JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR).
Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
