头孢他啶/阿维巴坦联合甲硝唑治疗复杂性腹腔内感染疗效及安全性的Meta分析-现代医学

头孢他啶/阿维巴坦联合甲硝唑治疗复杂性腹腔内感染疗效及安全性的Meta分析

单位：南京梅山医院药剂科, 江苏南京 210039

分类号：R979.9

出版年·卷·期（页码）：2023·51·第九期（1298-1306）

摘要：

目的：系统性评价头孢他啶/阿维巴坦(CAZ/AVI)联合甲硝唑在治疗复杂性腹腔内感染(cIAI)中的疗效及安全性。方法：计算机检索中国知网、万方数据知识平台、Cochrane图书馆、PubMed、Web of Science、Embase和主要会议记录，搜集从建库到2023年2月所有接受CAZ/AVI联合甲硝唑治疗cIAI的随机对照试验(RCT)。对符合纳入标准的研究进行资料提取并评价偏倚风险，采用RevMan 5.3软件对结果进行分析。结果：共纳入6项RCT，涉及2 412例患者，试验组干预措施为CAZ/AVI联合甲硝唑，对照组为碳青霉烯类药物。Meta分析结果显示，两组患者的临床治愈率(OR=0.77,95%CI 0.58~1.02,P=0.07)和微生物清除率(OR=0.72,95%CI 0.50~1.04,P=0.08)比较，差异无统计学意义；且成人亚组与儿童亚组的结果一致。安全性方面，两组总体药物不良事件发生率(OR=1.17,95%CI 0.99~1.37,P=0.06)和死亡率(OR=1.57,95%CI 0.77~3.18,P=0.21)比较，差异无统计学意义，但试验组比对照组患者更容易发生呕吐等胃肠道反应。对纳入研究绘制临床治愈率漏斗图，结果显示分布基本对称，不存在发表偏倚，结果可信。结论：在治疗cIAI时，CAZ/AVI联合甲硝唑与碳青霉烯类疗效及安全性相似，可作为治疗药物选择受限或碳青霉烯类耐药菌感染患者的替代方案。

Objective: To systematically evaluate the efficacy and safety of ceftazidime/avibactam(CAZ/AVI) plus metronidazolein the treatment of complicated intra-abdominal infection(cIAI). Method: CNKI,Wanfang Data Knowledge Platform,Cochrane Library,PubMed,Web of Science,Embase and major conference proceedings were searched by computer to collect all randomized controlled trials(RCTs) of CAZ/AVI plus metronidazole treatment for cIAI from the establishment of the databases to February 2023. Data were extracted from the studies that met the inclusion criteria,and the risk of bias was assessed. The results were analyzed using RevMan 5.3 software. Results: A total of 6 RCTs were included,involving 2 412 patients. The intervention measures of the experimental group were CAZ/AVI plus metronidazole and the control group was carbapenems. The results of the Meta-analysis showed that the clinical cure rates(OR=0.77,95%CI 0.58-1.02,P=0.07) and microbial clearance rate(OR=0.72,95%CI 0.50-1.04,P=0.08) of the two groups were similar,with no statistical significance,and the results of adult subgroup and child subgroup were consistent; In terms of safety,the overall incidence of adverse drug events(OR=1.17,95%CI 0.99-1.37,P=0.06) and mortality(OR=1.57,95%CI 0.77-3.18,P=0.21) were similar between the two groups,with no significant difference. However,subgroup analysis showed that patients in the experimental group were more prone to gastrointestinal reactions such as vomiting than those in the control group. Funnel plots of clinical cure rates were drawn for the included studies,and the results showed that the distribution was basically symmetrical without publication bias,and the results were credible. Conclusions: CAZ/AVI plus metronidazole has similar efficacy and safety to carbapenems in the treatment of cIAI and can be used as an alternative option for patients with limited drug choice or carbapenem-resistant bacteria infection.

参考文献：

[1] PAYÁ-LLORENTE C,MARTÍNEZ-LÓPEZ E,SEBASTIÁN-TOMÁS J C,et al.The impact of age and comorbidity on the postoperative outcomes after emergency surgical management of complicated intra-abdominal infections[J].Sci Rep,2020,10(1):1631-1639.
[2] LODISE T,YE M J,ZHAO Q.Prevalence of invasive infections due to carbapenem-resistant enterobacteriaceae among adult patients in U.S.hospitals[J].Antimicrob Agents Chemother,2017,61(8):1-6.
[3] ZHANG Y,WANG Q,YIN Y,et al.Epidemiology of carbapenem-resistant enterobacteriaceae infections:report from the China CRE Network[J].Antimicrob Agents Chemother,2018,62(2):1-11.
[4] 郭晓龙,崔向丽,李激扬.头孢他啶/阿维巴坦与碳青霉烯类疗效和安全性比较[J].中国新药杂志,2022,31(7):713-720.
[5] GARBER K.A beta-lactamase inhibitor revival provides new hope for old antibiotics[J].Nat Rev Drug Discov,2015,14(7):445-447.
[6] 赵锦锦,张菁.头孢他啶-阿维巴坦药品说明书[J].国外医药(抗生素分册),2019,40(2):115-127.
[7] LUCASTI C,POPESCU I,RAMESH M K,et al.Comparative study of the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem in the treatment of complicated intra-abdominal infections in hospitalized adults:results of a randomized,double-blind,Phase II trial[J].J Antimicrob Chemother,2013,68(5):1183-1192.
[8] CARMELI Y,ARMSTRONG J,LAUD P J,et al.Ceftazidime-avibactam or best available therapy in patients with ceftazidime-resistant enterobacteriaceae and pseudomonas aeruginosa complicated urinary tract infections or complicated intra-abdominal infections(REPRISE):a randomised,pathogen-directed,phase 3 study[J].Lancet Infect Dis,2016,16(6):661-673.
[9] MAZUSKI J E,GASINK L B,ARMSTRONG J,et al.Efficacy and safety of ceftazidime-avibactam plus metronidazole versus meropenem in the treatment of complicated intra-abdominal infection:results from a randomized,controlled,double-blind,phase 3 program[J].Clin Infect Dis,2016,62(11):1380-1389.
[10] QIN X,TRAN B G,KIM M J,et al.A randomised,double-blind,phase 3 study comparing the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem for complicated intra-abdominal infections in hospitalised adults in Asia[J].Int J Antimicrob Agents,2017,49(5):579-588.
[11] BRADLEY J S,BROADHURST H,CHENG K,et al.Safety and efficacy of ceftazidime-avibactam plus metronidazole in the treatment of children ≥ 3 months to <18 years with complicated intra-abdominal infection:results from a phase 2,randomized,controlled trial[J].Pediatr Infect Dis J,2019,38(8):816-824.
[12] RODGERS P,KAMAT S,ADHAV C.Ceftazidime-avibactam plus metronidazole vs. meropenem in complicated intra-abdominal infections:Indian subset from RECLAIM[J].J Infect Dev Ctries,2022,16(2):305-313.
[13] SHIRLEY M.Ceftazidime-avibactam:a review in the treatment of serious gram-negative bacterial infections[J].Drugs,2018,78(6):675-692.
[14] ZASOWSKI E J,RYBAK J M,RYBAK M J.The β-Lactams strike back:ceftazidime-avibactam[J].Pharmacotherapy,2015,35(8):755-770.
[15] CHE H,WANG R,WANG J,et al.Ceftazidime/avibactam versus carbapenems for the treatment of infections caused by enterobacteriaceae:a Meta-analysis of randomised controlled trials[J].Int J Antimicrob Agents,2019,54(6):809-813.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录