Piperacillin-tazobactam vs. carbapenems for treating hospitalized patients with ESBL-producing Enterobacterales bloodstream infections: A systematic review and meta-analysis

Article

作者: Cojutti, Pier Giorgio ; Pea, Federico ; Gatti, Milo

OBJECTIVESTo 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).METHODSTwo 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.RESULTSAfter 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).CONCLUSIONSThis 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.

2024-11-01·Clinical Microbiology and Infection

Empiric antibiotic regimens in adults with non-ventilator-associated hospital-acquired pneumonia: a systematic review and network meta-analysis of randomized controlled trials

Review

作者: Grant, Alexandre ; Aminaei, Danial ; Loeb, Mark ; Alvarado-Gamarra, Giancarlo ; Kim, William S H ; Brignardello-Petersen, Romina ; Agarwal, Arnav ; Couban, Rachel ; Basmaji, John ; Gomaa, Huda ; Motaghi, Shahrzad ; Guyatt, Gordon ; Wang, Ying ; Yao, Liang ; Sadeghirad, Behnam ; Likhvantsev, Valery ; Hazzan, Afeez Abiola ; Ghadimi, Maryam ; Lima, João Pedro ; Siemieniuk, Reed A C

BACKGROUNDThe optimal empiric antibiotic regimen for non-ventilator-associated hospital-acquired pneumonia (HAP) is uncertain.OBJECTIVESTo compare the effectiveness and safety of alternative empiric antibiotic regimens in HAP using a network meta-analysis.DATA SOURCESMedline, EMBASE, Cochrane CENTRAL, Web of Science, and CINAHL from database inception to July 06, 2023.STUDY ELIGIBILITY CRITERIARCTs.PARTICIPANTSAdults with clinical suspicion of HAP.INTERVENTIONSAny empiric antibiotic regimen vs. another, placebo, or no treatment.ASSESSMENT OF RISK OF BIASPaired reviewers independently assessed risk of bias using a modified Cochrane tool for assessing risk of bias in randomized trials.METHODS OF DATA SYNTHESISPaired reviewers independently extracted data on trial and patient characteristics, antibiotic regimens, and outcomes of interest. We conducted frequentist random-effects network meta-analyses for treatment failure and all-cause mortality and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach.RESULTSThirty-nine RCTs proved eligible. Thirty RCTs involving 4807 participants found low certainty evidence that piperacillin-tazobactam (RR compared to all cephalosporins: 0.65; 95% CI: 0.42, 1.01) and carbapenems (RR compared to all cephalosporins: 0.77; 95% CI: 0.53, 1.11) might be among the most effective in reducing treatment failure. The findings were robust to the secondary analysis comparing piperacillin-tazobactam vs. antipseudomonal cephalosporins or antipseudomonal carbapenems vs. antipseudomonal cephalosporins. Eleven RCTs involving 2531 participants found low certainty evidence that ceftazidime and linezolid combination may not be convincingly different from cephalosporin alone in reducing all-cause mortality. Evidence on other antibiotic regimens is very uncertain. Data on other patient-important outcomes including adverse events was sparse, and we did not perform network or pairwise meta-analysis.CONCLUSIONSFor empiric antibiotic therapy of adults with HAP, piperacillin-tazobactam might be among the most effective in reducing treatment failure. Empiric methicillin-resistant Staphylococcus aureus coverage may not exert additional benefit in reducing mortality.REGISTRATIONPROSPERO (CRD 42022297224).

2024-10-06·Zhonghua yu fang yi xue za zhi [Chinese journal of preventive medicine]

[Analysis of the changes of bacterial spectrum and drug resistance in sputum culture of ICU children in a hospital of pediatric in Jiangsu Province from 2017 to 2022].

Article

作者: Wang, C ; Huang, H ; Shen, H J ; Tan, Q X ; Xue, J ; Wei, J

目的： 探讨江苏省苏州地区2017—2022年重症监护室儿童下呼吸道感染（LRTI）病原菌分布及耐药特征变化。 方法： 采用横断面观察性研究方法，收集2017年1月至2022年12月在苏州大学附属儿童医院重症监护室的1 182例LRTI患儿，年龄1.00（0.25，4.00）岁，男性728例，女性454例。收集痰液标本采用细胞培养法检测病原菌，通过MALDI-TOF质谱仪进行细菌鉴定，并联合VITEK2 Compact全自动分析系统和纸片法进行药敏试验。运用χ²检验或Fisher确切概率法比较2017—2019年和2020—2022年ICU儿童痰培养阳性菌的分布和耐药性改变。 结果： 痰培养总体检出率42.06%（1 182/2 810），检出前三位的菌株为金黄色葡萄球菌（25.63%，303/1 182）、鲍曼不动杆菌（13.62%，161/1 182）和流感嗜血杆菌（13.28%，157/1 182）。2020—2022年鲍曼不动杆菌（17.90% vs. 11.02%，χ²=11.17，P=0.001），尤其是耐碳青霉烯类鲍曼不动杆菌（43.70% vs. 23.50%，χ²=15.21，P<0.001）比例较2017—2019年显著上升；而2020—2022年流感嗜血杆菌（8.50% vs. 16.19%，χ²=14.27，P<0.001）、肺炎链球菌（8.50% vs. 15.92%，χ²=13.42，P<0.001）和产超广谱-内酰胺酶大肠埃希菌（8.89% vs. 18.00%，χ²=5.45，P=0.025）比例较2017—2019年明显下降。药敏结果显示，2020—2022年鲍曼不动杆菌对亚胺培南（χ²=4.43，P=0.035）和左氧氟沙星（χ²=12.53，P<0.001）耐药性较2017—2019年明显增加，而对米诺环素（χ²=8.34，P=0，004）耐药率减低。2020—2022年大肠埃希菌对哌拉西林/他唑巴坦（χ²=8.29，P=0.008）、头孢哌酮/舒巴坦（χ²=5.07，P=0.024）的耐药率显著增加；肺炎克雷伯菌对一代、二代头孢菌素耐药率始终保持在60%以上，对喹诺酮类和碳青霉烯类药物敏感。2020—2022年金黄色葡萄球菌对左氧氟沙星（耐药率2.31%，7/303）和磺胺甲恶唑/甲氧苄啶（耐药率4.95%，15/303）仍保持高度敏感。 结论： 2020—2022年苏州大学附属儿童医院ICU患儿痰培养鲍曼不动杆菌检出率和耐药率明显升高，大肠埃希菌对β-内酰胺酶抑制剂复方制剂耐药也严重。定期监测ICU患儿呼吸道感染病原菌的分布和耐药特征改变对防治多重耐药菌感染尤为重要。.

100 项与 VIO-001 相关的药物交易

登录后查看更多信息