哌拉西林/他唑巴坦与头孢吡肟或碳青霉烯类药物治疗由细菌产生的染色体AmpC β -内酰胺酶引起的血流感染：一项系统回顾和荟萃分析

IF 5.4 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2024-12-04 DOI:10.1007/s15010-024-02447-y

Lorenzo Onorato, Ilaria de Luca, Annabella Salvati, Caterina Monari, Nicola Coppola

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引用次数: 0

摘要

背景：染色体AmpC （c-AmpC）产生肠杆菌引起的血流感染（BSI）的最佳治疗方法尚不明确。目的：描述使用哌拉西林/他唑巴坦、头孢吡肟或碳青霉烯类药物治疗c-AmpC β -内酰胺酶产生菌株引起的血流感染（BSIs）患者的临床和微生物学结果。数据来源：我们检索MEDLINE、Cochrane Library和EMBASE，筛选截至2024年1月发表的原始报告。研究资格标准：随机对照试验和观察性研究，调查使用哌拉西林/他唑巴坦、头孢吡肟或碳青霉烯类药物治疗的患者的全因死亡率、临床失败、微生物学失败或不良反应发生率。参与者：因c-AmpC产生菌引起血流感染的患者。干预措施：哌拉西林/他唑巴坦，头孢吡肟或碳青霉烯类作为靶向治疗。偏倚风险评估：我们对随机对照试验使用Cochrane偏倚风险工具，对观察性研究使用纽卡斯尔渥太华量表。数据综合方法：采用随机效应模型对风险比（rr）进行meta分析。结果：我们筛选了1720份原始报告，并纳入了20项研究（1项rct， 1项病例对照研究，18项队列研究），共2,834例患者。当比较哌拉西林/他唑巴坦与替代治疗（头孢吡肟或碳青霉烯类）时，治疗组之间的死亡率无显著差异(RR: 1.1；95% CI: 0.76-1.58, p = 0.61)，而微生物失败率较高(RR: 1.80；95% CI: 1.15-2.82, p = 0.01)和临床失败(RR: 1.54；95% CI: 1.00-2.40, p = 0.05)，在接受哌拉西林/他唑巴坦治疗的患者中观察到。使用头孢吡肟或碳青霉烯类药物治疗的患者在微生物学和临床失败率方面没有差异，接受头孢吡肟治疗的患者死亡率较低(RR: 0.74；95% CI: 0.59-0.94, p = 0.014)。结论：由于产生ampc的菌株，对于BSI，头孢吡肟是碳青霉烯类药物的绝佳替代品，而哌拉西林/他唑巴坦与更高的临床和微生物失败率相关。迫切需要进行随机临床试验，以确定在这些感染中最佳的碳青霉烯保留策略。

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Piperacillin/tazobactam vs. cefepime or carbapenems for the treatment of bloodstream infections due to bacteria producing chromosomal AmpC beta-lactamase: a systematic review and meta-analysis.

Background: The best treatment for bloodstream infections (BSI) due to chromosomal AmpC (c-AmpC) producing Enterobacterales is not clearly defined.

Objectives: To describe the clinical and microbiological outcomes of patients treated with piperacillin/tazobactam, cefepime or carbapenems for bloodstream infections (BSIs) due to c-AmpC beta-lactamase-producing strains.

Data sources: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to January 2024.

Study eligibility criteria: RCTs and observational studies investigating all-cause mortality, clinical failure, microbiological failure or rate of ADRs of patients treated with piperacillin/tazobactam, cefepime or carbapenems.

Participants: Patients with bloodstream infections due to c-AmpC producing bacteria.

Interventions: Piperacillin/tazobactam, cefepime or carbapenems as targeted treatment.

Assessment of risk of bias: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies.

Methods of data synthesis: We conducted a meta-analysis pooling Risk ratios (RRs) through random effect models.

Results: We screened 1,720 original reports, and 20 studies (1 RCTs, 1 case-control study, 18 cohort studies) were included in the analysis, for a total of 2,834 patients. When comparing piperacillin/tazobactam with alternative treatments (cefepime or carbapenems), no significant difference in mortality rate was observed between the treatment groups (RR: 1.1; 95% CI: 0.76-1.58, p = 0.61), while an higher rate of microbiological failure (RR: 1.80; 95% CI: 1.15-2.82, p = 0.01) and clinical failure (RR: 1.54; 95% CI: 1.00-2.40, p = 0.05) was observed among patients receiving piperacillin/tazobactam. No difference was observed in microbiological and clinical failure rate among patients treated with cefepime or carbapenems, with a lower mortality rate in those receiving cefepime (RR: 0.74; 95% CI: 0.59-0.94, p = 0.014).

Conclusions: Cefepime represents an excellent alternative to carbapenems for BSI due to AmpC-producing strains, whereas piperacillin/tazobactam is associated with a higher rate of clinical and microbiological failure. There is an urgent need for randomized clinical trials that aim to define the best carbapenem-sparing strategy in these infections.

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.