双碳青霉烯类抗生素治疗碳青霉烯类耐药菌感染的荟萃分析  

Effectiveness of double-carbapenem therapy on carbapenem-resistant infections:a meta-analysis

作　　者：赖静[1] 张琪[1] 梁园[1] 刘滔滔[2] 温燕[2] 张宏亮[2] LAI Jing;ZHANG Qi;LIANG Yuan;LIU Taotao;WEN Yan;ZHANG Hongliang(Department of Pharmacy,No.923 Hospital of People's Liberation Army,Nanning 530021,China)

机构地区：[1]中国人民解放军第923医院药剂科,南宁530021 [2]广西医科大学第一附属医院药学部

出　　处：《中国感染与化疗杂志》2019年第3期300-305,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的系统评价双碳青霉烯类抗生素联用治疗碳青霉烯类耐药肠杆菌/肺炎克雷伯菌(CRE/CRKP)感染的疗效和安全性,以期为临床治疗提供循证参考。方法通过计算机检索Cochrane、PubMed、Embase、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库、万方数据库,收集有关双碳青霉烯类抗生素治疗碳青霉烯类耐药菌感染的研究,检索年限截至2018年1月。由2位研究者独立筛选文献、提取资料、评价质量,并评价纳入研究的质量后,采用REVMAN 5.3软件和GRADE软件进行数据分析。结果共纳入3篇英文文献,均为病例对照研究,合计212例患者。荟萃分析显示:双碳青霉烯类联用可降低28/30 d死亡率(OR=0.41,95%CI:0.21～0.79,P=0.007),改善临床疗效(OR=2.07,95%CI:1.10～3.88,P=0.02),提高细菌清除率(OR=2.05,95%CI:1.05～3.99,P=0.04)。GRADE系统推荐分级为低等级、弱推荐。结论双碳青霉烯类联用可增强对CRE/CRKP的抗菌作用。Objective To assess the efficacy and safety of double-carbapenem therapy(DCT)in the treatment of carbapenemresistant Enterobacteriaceae(CRE)or carbapenem-resistant Klebsiella pneumoniae(CRKP)by meta-analysis.Methods We conducted a comprehensive literature search for the double-carbapenem therapy on carbapenem-resistance infection in Cochrane library,PubMed,Embase,CBM,CNKI,VIP and WanFang Date,which were published before January 2018.Data extraction and quality evaluation of the studies were conducted by two researchers independently.RevMan 5.3 software was used for metaanalysis and GRADE was used for evidence evaluation and recommendation grading.Results Three case-control studies in English involving 212 patients were included.Meta-analysis showed that DCT could reduce the 28/30-day mortality(OR=0.41,95%CI:0.21-0.79,P=0.007),and increase clinical cure rate and the microbiological eradication rate(OR=2.07,95%CI:1.10-3.88,P=0.02;OR=2.05,95%CI:1.05-3.99,P=0.04).GRADE showed that the 3 outcomes were all based on low quality evidence.Conclusions Double-carbapenem therapy can enhance the antibacterial activity against CRE/CRKP infections.

关 键 词：双碳青霉烯类 碳青霉烯类耐药肠杆菌 碳青霉烯类耐药肺炎克雷伯菌 荟萃分析 循证医学 

分 类 号：R516[医药卫生—内科学] R978.1[医药卫生—临床医学]