头孢他啶/阿维巴坦治疗多重耐药肠杆菌感染的有效性与安全性的Meta分析  

Efficacy and Safety of Ceftazidime/Avibactam for Multidrug-resistant Enterobacteriaceae Infections:a Meta-analysis

作　　者：李锐 唐志勇 彭媛[1] 周玥[1] 刘福[1] 杨明[1] LI Rui;TANG Zhiyong;PENG Yuan;ZHOU Yue;LIU Fu;YANG Ming(Department of Pharmacy,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Pharmacy,Nanchong Central Hospital/The Second Affiliated Medical College of North Sichuan Medical College,Nanchong Key Laboratory of Individualized Drug Therapy,Nanchong 637000,China;Nanchong Jialing District People's Hospital/Nanchong Central Hospital Jialing Branch,Nanchong 637900,China)

机构地区：[1]川北医学院附属医院药剂科,四川省南充市637000 [2]四川省南充市中心医院,川北医学院第二临床医学院药学部个体化药物治疗南充市重点实验室,637000 [3]四川省南充市嘉陵区人民医院南充市中心医院嘉陵院区,637900

出　　处：《中国全科医学》2022年第23期2932-2938,共7页Chinese General Practice

基　　金：2018年四川省科技计划项目(2018JY0415);北京康盟慈善基金会医学科研发展基金项目(B21010CS)。

摘　　要：背景 多重耐药肠杆菌(MDR-EB)感染已成为全球住院患者的治疗难题,其发病率和严重程度呈上升趋势。目的 系统评价头孢他啶/阿维巴坦(CAZ/AVI)治疗MDR-EB感染的有效性与安全性。方法 系统检索中国知网、万方数据知识服务平台、维普网、PubMed、EMBase、Cochrane Library数据库中涉及CAZ/AVI治疗MDR-EB感染的随机对照试验(RCT)或临床对照试验(CCT),其中试验组采用包含CAZ-AVI的药物治疗方案,对照组采用其他治疗措施。检索时间为建库至2021年2月。由两位评审人员进行文献筛选、数据提取及质量评价,采用RevMan 5.1软件进行Meta分析。结果 共纳入12篇文献、15项研究。Meta分析结果显示,两组临床治愈率、细菌清除率、药物不良反应发生率比较,差异均无统计学意义〔OR=1.02,95%CI(0.73,1.43),P=0.90;OR=1.23,95%CI(0.96,1.58),P=0.10;OR=1.02,95%CI(0.85,1.22),P=0.84〕。试验组死亡率低于对照组〔OR=0.72,95%CI(0.52,0.99),P=0.04〕。绘制临床治愈率的漏斗图,结果显示,漏斗图分布基本对称。对临床治愈率、细菌清除率及死亡率进行Egger’s检验,结果显示,三者无发表偏倚存在(P=0.234、0.679、0.056)。结论 CAZ-AVI可以降低MDR-EB感染患者的死亡率,可以作为MDR-EB,特别是耐碳青霉烯肠杆菌感染患者的可选方案之一。Background As a global health challenge,multidrug-resistant Enterobacteriaceae(MDR-EB) infection in inpatients shows an upward trend in its incidence and degree of severity.Objective To systematically evaluate the efficacy and safety of ceftazidime/avibactam(CAZ/AVI) in MDR-EB infection.Methods Databases including China National Knowledge Infrastructure,Wanfang Data,CQVIP,PubMed,EMBase,and Cochrane Library were searched for randomized controlled trials(RCTs) and controlled clinical trials (CCTs) about treating MDR-EB infection using CAZ/AVI(experimental group) versus other treatments(control group) from inception to February 2021.Literature selection,data extraction and quality evaluation were carried out by two reviewers.Meta-analysis was performed using the RevMan 5.1.Results In all,12 articles involving 15 trials were included.Meta-analysis indicated that both groups had no significant differences in clinical cure rate〔OR=1.02,95%CI(0.73,1.43),P=0.90〕,MDR-EB clearance rate〔OR=1.23,95%CI(0.96,1.58),P=0.10〕and rate of adverse drug reactions〔OR=1.02,95%CI(0.85,1.22),P=0.84〕.But the mortality rate〔OR=0.72,95%CI(0.52,0.99),P=0.04〕was lower for experimental group.The funnel plot was basically symmetrical in shape in assessing the existence of publication bias in the articles in terms of the clinical cure rate.Egger’s test identified no publication bias in the articles regarding clinical cure rate,MDR-EB clearance rate and mortality rate(P=0.234,0.679,0.056).Conclusion CAZ/AVI treatment could reduce the mortality rate in patients infected with MDR-EB,which may be used as an alternative for MDR-EB infection,especially carbapenem-resistant Enterobacterales infection.

关 键 词：多重耐药肠杆菌 头孢他啶/阿维巴坦 有效性 安全性 META分析 

分 类 号：R378.2[医药卫生—病原生物学]