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
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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.
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.
引文
[1]MACKENZIE F M,FORBES K J,Dorai-john T,et al.Emergence of a carbapenem-resistant Klebsiella pneumonian[J].Lancet,1997,350(9080):783.
[2]World Health Organization.Antimicrobial resistance global report on surveillance[R/OL].[2018-08-03].http://www.who.int/drugresistance/documents/surveillancereport/en/.
[3]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[4]HU F,CHEN S,XU X,et al.Emergence of carbapenemresistant clinical Enterobacteriaceae isolates from a teaching hospital in Shanghai,China[J].J Med Microbiol,2012,61(Pt1):132-136.
[5]VAN DUIN D,KAYE K S,NEUNER E A,et al.Carbapenemresistant Enterobacteriaceae:a review of treatment and outcomes[J].Diagn Microbiol Infect Dis,2013,75(2):115-120.
[6]ZHAO F,ZHANG J,FU Y,et al.Dissemination of extensively drug-resistant and KPC-2 producing Klebsiella pneumonia isolated from bloodstream infections[J].J Infect Dev Ctries,2015,9(9):1016-1021.
[7]DE PASCALE G,MARTUCCI G,MONTINI L,et al.Double carbapenem as a rescue strategy for the treatment of severe carbapenemase-producing Klebsiella pneumoniae infections:a two-center,matched case-control study[J].Critical Care,2017,21(1):173.
[8]VENUGOPALAN V,NOGID B,LE T N,et al.Double carbapenem therapy(DCT)for bacteremia due to carbapenemresistant Klebsiella pneumoniae(CRKP):from test tube to clinical practice[J].Infect Dis(Lond),2017,49(11-12):867-870.
[9]OLIVA A,SCORZOLINI L,CASTALDI D.Doublecarbapenem regimen,alone or in combination with colistin,in the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae(CR-Kp)[J].J Infect,2017,74(1):103-106.
[10]曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具[J].中国循证心血管医学杂志,2012,4(4):297-299.
[11]OWNBY R L,CROCCO E,ACEVEDO A,et al.Depression and risk for Alzheimer disease:systematic review,metaanalysis[J].Arch Gen Psychiatry,2006,63(5):530-538.
[12]DERYKE C A,BANEVICIUS M A,FAN H W,et al.Bactericidal activities of meropenem and ertapenem against extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a neutropenic mouse thigh model[J].Antimicrob Agents Chemother,2007,51(9):1481-1486.
[13]BULIK C C,NICOLAU D P.Double-carbapenem therapy for carbapenemase producing Klebsiella pneumonia[J].Antimicrob Agents Chemother,2011,55(6):3002-3004.
[14]GIAMARELLOU H,GALANI L,BAZIAKA F,et al.Effectiveness of a double carbapenem regimen for infections in humans due to carbapenemase producing pandrug resistant Klebsiella pneumonia[J].Antimicrob Agents Chemother,2013,57(5):2388-2390.
[15]WISKIRCHEN D E,CRANDON J L,NICOLAU D P,et al.Impact of various conditions on the efficacy of dual carbapenem therapy against KPC-producing Klebsiella pneumoniae[J].Int JAntimicrob Agents,2013,41(6):582-585.
[2]World Health Organization.Antimicrobial resistance global report on surveillance[R/OL].[2018-08-03].http://www.who.int/drugresistance/documents/surveillancereport/en/.
[3]胡付品,郭燕,朱德妹,等.2017年CHINET中国细菌耐药性监测[J].中国感染与化疗杂志,2018,18(3):241-251.
[4]HU F,CHEN S,XU X,et al.Emergence of carbapenemresistant clinical Enterobacteriaceae isolates from a teaching hospital in Shanghai,China[J].J Med Microbiol,2012,61(Pt1):132-136.
[5]VAN DUIN D,KAYE K S,NEUNER E A,et al.Carbapenemresistant Enterobacteriaceae:a review of treatment and outcomes[J].Diagn Microbiol Infect Dis,2013,75(2):115-120.
[6]ZHAO F,ZHANG J,FU Y,et al.Dissemination of extensively drug-resistant and KPC-2 producing Klebsiella pneumonia isolated from bloodstream infections[J].J Infect Dev Ctries,2015,9(9):1016-1021.
[7]DE PASCALE G,MARTUCCI G,MONTINI L,et al.Double carbapenem as a rescue strategy for the treatment of severe carbapenemase-producing Klebsiella pneumoniae infections:a two-center,matched case-control study[J].Critical Care,2017,21(1):173.
[8]VENUGOPALAN V,NOGID B,LE T N,et al.Double carbapenem therapy(DCT)for bacteremia due to carbapenemresistant Klebsiella pneumoniae(CRKP):from test tube to clinical practice[J].Infect Dis(Lond),2017,49(11-12):867-870.
[9]OLIVA A,SCORZOLINI L,CASTALDI D.Doublecarbapenem regimen,alone or in combination with colistin,in the treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae(CR-Kp)[J].J Infect,2017,74(1):103-106.
[10]曾宪涛,刘慧,陈曦,等.Meta分析系列之四:观察性研究的质量评价工具[J].中国循证心血管医学杂志,2012,4(4):297-299.
[11]OWNBY R L,CROCCO E,ACEVEDO A,et al.Depression and risk for Alzheimer disease:systematic review,metaanalysis[J].Arch Gen Psychiatry,2006,63(5):530-538.
[12]DERYKE C A,BANEVICIUS M A,FAN H W,et al.Bactericidal activities of meropenem and ertapenem against extended-spectrum-beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a neutropenic mouse thigh model[J].Antimicrob Agents Chemother,2007,51(9):1481-1486.
[13]BULIK C C,NICOLAU D P.Double-carbapenem therapy for carbapenemase producing Klebsiella pneumonia[J].Antimicrob Agents Chemother,2011,55(6):3002-3004.
[14]GIAMARELLOU H,GALANI L,BAZIAKA F,et al.Effectiveness of a double carbapenem regimen for infections in humans due to carbapenemase producing pandrug resistant Klebsiella pneumonia[J].Antimicrob Agents Chemother,2013,57(5):2388-2390.
[15]WISKIRCHEN D E,CRANDON J L,NICOLAU D P,et al.Impact of various conditions on the efficacy of dual carbapenem therapy against KPC-producing Klebsiella pneumoniae[J].Int JAntimicrob Agents,2013,41(6):582-585.