7天与14天抗生素治疗成人血流感染的临床结果和安全性：一项系统综述和荟萃分析，采用试验序列分析

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-06-02 DOI:10.1016/j.jiph.2025.102852

Chen-Wei Wu , Chih-Cheng Lai , Jheng-Yan Wu , Mei-Chuan Lee

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引用次数: 0

摘要

抗生素治疗血流感染（bsi）的最佳持续时间仍不确定。这项荟萃分析与试验序贯分析（TSA）比较了成人7天和14天抗生素疗程的疗效和安全性。系统检索PubMed、Embase和Cochrane图书馆，确定了4个随机对照试验（4794例患者）。与14天相比，7天疗程的90天全因死亡率（RR 0.94, 95 % CI 0.79-1.12, p = 0.51）和菌血症复发率（RR 1.15, 95 % CI 0.80-1.64, p = 0.45）相似。两组在急性肾损伤、腹泻、过敏反应和艰难梭菌感染等不良事件方面无显著差异。运输安全管理局指出信息不足。虽然90天死亡率是一个客观终点，但它可能不能完全反映临床恢复或长期后遗症。尽管如此，研究结果表明，在非高危患者中，7天的抗生素疗程与14天的疗程效果相当，支持与抗菌药物管理一致的较短疗程。

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Clinical outcomes and safety of 7-day versus 14-day antibiotic therapy for bloodstream infections in adults: A systematic review and meta-analysis with trial sequential analysis

The optimal duration of antibiotic therapy for bloodstream infections (BSIs) remains uncertain. This meta-analysis with trial sequential analysis (TSA) compared the efficacy and safety of 7-day versus 14-day antibiotic courses in adults. A systematic search of PubMed, Embase, and Cochrane Library identified four randomized controlled trials (4794 patients). The 7-day course showed similar 90-day all-cause mortality (RR 0.94, 95 % CI 0.79–1.12, p = 0.51) and bacteremia relapse rates (RR 1.15, 95 % CI 0.80–1.64, p = 0.45) compared to 14 days. No significant differences were found in adverse events, including acute kidney injury, diarrhea, allergic reactions, and Clostridioides difficile infections. TSA indicated an insufficient information size. While 90-day mortality is an objective endpoint, it may not fully capture clinical recovery or long-term sequelae. Nonetheless, the findings indicate that a 7-day antibiotic course achieves outcomes comparable to a 14-day regimen in non–high-risk patients, supporting shorter durations consistent with antimicrobial stewardship.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.