双碳青霉烯类药物治疗耐碳青霉烯肠杆菌感染的有效性系统评价和Meta分析  

Efficacy of double-carbapenem regimen in the treatment of carbapenem-resistant enterobacter infection:A systematic review and meta-analysis

作　　者：李锐 唐志勇 李胜前[1] 刘福[1] 杨明[1] Li Rui;Tang Zhi-yong;Li Sheng-qian;Liu Fu;Yang Ming(Department of Pharmacy,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000;Department of Pharmacy,Nanchong Central Hospital,The Second Affiliated Clinical Medical College of North Sichuan Medical College,Nanchong 637000;Nanchong Jialing District People’s Hospital(Nanchong Central Hospital Jialing Branch),Nanchong 637900)

机构地区：[1]川北医学院附属医院药剂科,南充637000 [2]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,南充637000 [3]南充市嘉陵区人民医院(南充市中心医院嘉陵院区),南充637900

出　　处：《中国抗生素杂志》2023年第2期235-240,I0001,共7页Chinese Journal of Antibiotics

基　　金：2018年四川省科技计划项目(No.2018JY0415);2020年南充市应用技术研究与开发专项项目(No.20YFZJ0014);北京康盟慈善基金会医学科研发展基金项目(No.B21010CS)。

摘　　要：目的系统评价双碳青霉烯类药物治疗耐碳青霉烯肠杆菌感染(carbapenem-resistant enterobacter,CRE)细菌所致感染的有效性。方法通过计算机检索中国知网、中国万方、Cochrane Library和PubMed等数据库中与双碳青霉烯类药物治疗CRE感染相关的临床研究,提取文献可用数据并对纳入的文献进行质量评估。应用软件STATA 12.0版本和RevMan 5.1版本对统计数据作Meta分析和系统评价。结果总共包含5篇文献6个研究,共698名患者被纳入。分析结果表明,治疗CRE感染时,双碳青霉烯组(实验组)与其它治疗药物组(对照组)的微生物清除率存在显著性差异[57.81%vs 38.05%;OR=2.05,95%CI(1.05,3.99),P=0.04],即实验组微生物清除率更高。然而,两组比较,临床治愈率[69.42%vs 65.17%;OR=1.43,95%CI(0.89,2.29),P=0.14]和死亡率[33.61%vs 35.82%;OR=0.72,95%CI(0.44,1.17),P=0.18]均无显著性差异。结论双碳青霉烯类抗菌药物治疗CRE感染时,虽不能提高患者的临床治愈率以及降低死亡率,但能显著提高微生物清除率,因此,可作为治疗CRE感染时的重要可选方案之一。Objective To systematically evaluate the effectiveness of double-carbapenem regimen in the treatment of carbapenem-resistant Enterobacter(CRE)infection.Methods Clinical studies of double-carbapenem regimen for the treatment of carbapenem-resistant Enterobacter infection published in China national knowledge Infrastructure,Wanfang data,Cochrane library,and PubMed databases were searched.The available data were extracted and the quality of the included literatures was assessed.Meta-analysis and systematic evaluation were performed by RevMan 5.1 and STATA 12.0 software.Results A total of six studies with 698 patients were included in five literatures.The results showed that there was a significant difference in bacterial clearance rate between the double-carbapenem group(the experimental group)and other therapeutic drugs group(the control group)[57.81%vs 38.05%;OR=2.05,95%CI(1.05,3.99),P=0.04]in the treatment of CRE infection.The experimental group had a higher bacterial clearance rate.However,there was no significant difference in cure rate[69.42%vs 65.17%;OR=1.43,95%CI(0.89,2.29),P=0.14]and mortality rate[33.61%vs 35.82%;OR=0.72,95%CI(0.44,1.17),P=0.18]between the two groups.Conclusion In the treatment of CRE infection,double-carbapenems can not improve the cure rate and reduce the mortality rate of patients,but can significantly improve the bacterial clearance rate,and can be used as one of the important options in the treatment of CRE infection.

关 键 词：双碳青霉烯 耐碳青霉烯肠杆菌 有效性 系统评价 

分 类 号：R978.1[医药卫生—药品]