氨曲南和万古霉素联合治疗复杂性细菌性皮肤和皮肤软组织感染疗效和安全性的Meta分析  

Aztreonam plus vancomycinin treatment of complicated skin and skin structure infections:A Meta-analysis

作　　者：许月芳[1] 张鑫[1] 周亮[1] 刘皈阳[1] 

机构地区：[1]解放军总医院第一附属医院药剂药理科,北京100048

出　　处：《临床药物治疗杂志》2017年第4期19-24,共6页Clinical Medication Journal

基　　金："十二五"国家科技支撑计划课题项目"安全合理用药评价和干预技术研究与应用"(2013BAI06B04)

摘　　要：目的:探讨比较氨曲南联合万古霉素治疗复杂性细菌性皮肤和皮肤软组织感染(c SSSIs)的疗效和安全性。方法:检索维普、万方、CNKI、Cochrane、EMbase、PubMed、Medline等文献数据库。依据Cochrane Handbook5.1.0评价方法查找氨曲南联合万古霉素治疗复杂性细菌性皮肤和皮肤软组织感染的随机对照试验(RCT),进行数据提取和质量评价后,采用RevMan 5.2软件进行Meta分析。结果:共纳入4个RCT的文献,2494名患者。Meta分析结果显示:在临床治愈率(WMD=1.20,95%CI:0.89~1.61,P=0.24)、检出微生物人群中的临床治愈率(WMD=1.29,95%CI:0.89~1.87,P=0.18)、检出大肠杆菌人群中的临床治愈率(WMD=0.67,95%CI:0.14~3.10,P=0.61)方面没有显著性差异;在不良反应腹泻(WMD=0.65,95%CI:0.46~0.93,P=0.02)、恶心(WMD=0.37,95%CI:0.14~0.93,P=0.03)发生率方面氨曲南联合万古霉素显著低于对照组;头痛发生率没有显著性差异(WMD=0.81,95%CI:0.58~1.12,P=0.20)。结论:氨曲南联合万古霉素是治疗c SSSIs的一种经典治疗方案,从目前的临床疗效评价结果来看,仍然具有重要的临床应用价值,期待更多的大样本研究进一步证实。Objective： To evaluate the efficacy and safety of Aztreonam plus vancomycin in the treatment of complicated skin and skin structure infections by randomized controlled trials（RCTs）. Methods： Randomized controlled trials of Aztreonam plus vancomycinin treatment of complicated skin and skin structure infections were collected from the PubMed, EMbase, Medline, The Cochrane Library, Wangfang, CNKI and VIP databases.The methodological quality of included studies was evaluated, and data analyses were performed with Rev Man Version 5.2. Results： A total of 4 RCTs including 2494 patients met the inclusion criteria. The results of Meta-analyses showed that CE （the clinically evaluable）（WMD=1.20, 95% C1：0.89-1.61, P=0.24）, ME （The microbiologically evaluable） （WMD=1.29, 95% CI ：0.89-1.87, P=0.18） and clinical cure rate by baseline potential pathogen Escherichia coli （WMD=0.67, 95% CI：O. 14-3.10, P=0.61） were nonotable significance.The risk of diarrhea （WMD=0.65, 95% CI：0.46-0.93, P=0.02）, nausea （WMD=0.37, 95% CI：0.14-0.93, P=0.03） is lowerin aztreonam plus vancomycin treatment than control group. The risk of headache （WMD=0.81, 95% CI：0.58-1.12, P=0.20） were no notable significance. Conclusion： According to the evidences, the clinical efficacy rate of aztreonam plus vancomycin in the treatment of complicated skin and skin structure infectionswas safety and effectiveness. However, morehigh quality clinical trials are expected for further study.

关 键 词：氨曲南 万古霉素 cSSSIs META分析 随机对照试验 

分 类 号：R969.3[医药卫生—药理学]