万古霉素静脉滴注与联合鞘内注射治疗颅内感染效果及安全性的Meta分析
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摘要
目的比较万古霉素静脉滴注与静脉滴注联合鞘内注射治疗颅内感染的效果及安全性。方法计算机检索Pubmed、The Cochrane Library、Elsevier Clinical Key、FMJS以及中国期刊全文数据库、中国生物医学文献数据库、万方数据库、维普中文科技期刊数据库中的文献,检索时限为建库时间至2017年6月。搜集关于万古霉素静脉滴注与静脉滴注联合鞘内注射2种不同给药方式治疗颅内感染的病例对照研究,对检索到的文献进行数据提取和质量评价,并采用Revman 5.3软件进行Meta分析。结果最终纳入5篇回顾性队列研究,共248例患者,其中静脉滴注组112例,静脉滴注联合鞘内注射组136例。Meta分析结果显示:静脉滴注组与静脉滴注联合鞘内注射组临床有效率(比值比=6.24,95%置信区间:2.68～14.54,P<0.001)及治愈时间(比值比=-4.78,95%置信区间:-7.59～-1.96,P<0.001)比较差异均有统计学意义,2种不同给药方式所致不良反应(比值比=1.38,95%置信区间:0.45-4.50,P=0.59)比较差异无统计学意义。结论万古霉素静脉滴注联合鞘内注射治疗颅内感染的临床有效率高于静脉滴注组,并能缩短治疗时间,且不增加不良反应。
Objective To analyze the efficacy and safety of vancomycin intravenous drip infusion and intravenous drip infusion combined with intrathecal injection in treatment of intracranial infection. Methods Casecontrol studies about vancomycin intravenous drip infusion and intrathecal injection combined with intravenous drip infusion treating intracranial infection were searched in Pubmed, Cochrane Library, Elsevier Clinical Key, FMJS,Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Wanfang Database and VIP Database until June 2017. Revman 5. 3 software was used for data analysis. Results Five respective cohort studies including 248 patients were reviewed; 112 patients were treated by intravenous drip infusion of vancomycin;136 patients were treated by vancomycin via intravenous drip infusion combined with intrathecal injection. Meta analysis showed that the clinical effective rate(odds ratio =6. 24, 95% confidence interval: 2.68-14.54, P<0.001) and healing time(odds ratio =-4.78, 95% confidence interval:-7.59 to-1.96, P <0.001) had significant differences between intravenous drip infusion group and intravenous drip infusion combined with intrathecal injection group; adverse drug reactions showed no significant difference between groups[OR= 1. 38, 95% confidence interval: 0.43-4.50, P = 0. 59]. Conclusion Vancomycin intravenous drip infusion combined with intrathecal injection treating intracranial infection is better than intravenous drip infusion in improving clinical efficacy and shortening cure time without increasing adverse reaction.
Objective To analyze the efficacy and safety of vancomycin intravenous drip infusion and intravenous drip infusion combined with intrathecal injection in treatment of intracranial infection. Methods Casecontrol studies about vancomycin intravenous drip infusion and intrathecal injection combined with intravenous drip infusion treating intracranial infection were searched in Pubmed, Cochrane Library, Elsevier Clinical Key, FMJS,Chinese Journal Full-text Database, Chinese Biomedical Literature Database, Wanfang Database and VIP Database until June 2017. Revman 5. 3 software was used for data analysis. Results Five respective cohort studies including 248 patients were reviewed; 112 patients were treated by intravenous drip infusion of vancomycin;136 patients were treated by vancomycin via intravenous drip infusion combined with intrathecal injection. Meta analysis showed that the clinical effective rate(odds ratio =6. 24, 95% confidence interval: 2.68-14.54, P<0.001) and healing time(odds ratio =-4.78, 95% confidence interval:-7.59 to-1.96, P <0.001) had significant differences between intravenous drip infusion group and intravenous drip infusion combined with intrathecal injection group; adverse drug reactions showed no significant difference between groups[OR= 1. 38, 95% confidence interval: 0.43-4.50, P = 0. 59]. Conclusion Vancomycin intravenous drip infusion combined with intrathecal injection treating intracranial infection is better than intravenous drip infusion in improving clinical efficacy and shortening cure time without increasing adverse reaction.
引文
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[10]陈献东,蔡建勇,巴华君,等.静脉与鞘内联合应用万古霉素治疗患者开颅术后颅内感染的疗效观察[J].中华医院感染学杂志,2016,26(7):1569-1571.DOI:10.11816/cn.ni.2016-152777.Chen XD,Cai JY,Ba HJ,et al.Efficacy of combined application of vancomycin in the treatment of intracranial infections after craniotomy[J].Chinese Journal of Nosocomiology,2016,26(7):1569-1571.DOI:10.11816/cn.ni.2016-152777.
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[12]王婧,谷亮,张明,等.儿童颅底骨折合并颅内感染万古霉素鞘内注射联合静脉用药的疗效[J].江苏医药,2016,42(10):1168-1170.Wang J,Gu L,Zhang M,et al.Clinical efficacy observation of intravenous and intraventricular combine with intravenous of vancomycin in treatment of skull base fracture in children with intracranial infection[J].Jiangsu Medical Journal,2016,42(10):1168-1170.
[13]Popa D,Loewenstein L,Lam SW,et al.Therapeutic drug monitoring of cerebrospinal fluid vancomycin concentration duringintraventricular administration[J].J Hosp Infect,2016,92(2):199-202.DOI:10.1016/j.jhin.2015.10.017.
[14]Gilbert DN,Chambers HF,Eliopoulos GM,et al.桑福德抗微生物治疗指南[M].范洪伟,王焕玲,周宝桐,等,译.46版.北京:中国协和医科大学出版社,2017:107.Gilbert DN,Chambers HF,Eliopoulos GM,et al.The Sanford guide to antimicrobial therapy[M].Fan HW,Wang HL,Zhou BT,et al,translate.46th ed.Beijing:Peking Union Medical College Press,2017:107.
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[16]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版)[EB/OL].(2015-07-24)[2017-10-18].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf.Revised group of guiding principle of clinical application ofantibacterials.Guiding principle of clinical application of antibacterials2015[EB/OL].(2015-07-24)[2017-10-18].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf.
[17]Schwabe M,Jttner E,Blaich A,et al.Cure of ventriculitis and central nervous system shunt infection by Staphylococcus epidermidis with vancomycin by inlraventricular injection in a liver transplant recipient[J].Transpl Infect Dis,2007,9(1):46-50.DOI:10.1111/j.1399-3062.2006.00157.x.
[18]Cao DM,Jiang JG,Wu YK.Effects of intrathecal injection of Vancomycin combined external drainage of lumbar cistern for treatment of intracranial infection[J].J Clin Neurosurg,2015,12(1):64-65.
[2]Dashti SR,Baharvahdat H,Spetzler RF,et al.Operative intracranial,infection following craniotomy[J].Neurosurg Focus,2008,24(6):E10.DOI:10.3171/FOC/2008/24/6/E10.
[3]李倩,武元星,唐明忠,等.神经外科患者脑脊液病原菌分布及耐药性变迁[J].中国感染控制杂志,2015,14(3):159-165.DOI:10.3969/j.issn.1671-9638.2015.03.003.Li Q,Wu YX,Tang MZ,et al.Distribution and drug resistance change of bacteria isolated from cerebro-spinal fluid of neurosurgery patients[J].Chinese Journal of Infection Control,2015,14(3):159-165.DOI:10.3969/j.issn.1671-9638.2015.03.003.
[4]Wu Y,Kang J,Wang Q.Drug concentrations in the serum and cerebrospinal fluid of patients treated with norvancomycin aftercraniotomy[J].Eur J Clin Microbiol Infect Dis,2017,36(2):305-311.DOI:10.1007/s10096-016-2803-9.
[5]Lutsar I,McCracken GH Jr,Friedland IR.Antibiotic pharmacodynamics in cerebrospinal fluid[J].Clin Infect Dis,1998,27(5):1117-1129.
[6]Jadad AR,Moore RA,Carroll D,et al.Assessing the quality of reports of randomized clinical trials:is blinding necessary?[J].Control Clin Trials,1996,17(1):1-12.
[7]Lo CK,Mertz D,Loeb M.Newcastle-Ottawa Scale:comparing reviewers'to authors'assessments[J].BMC Med Res Methodol,2014,14:45.DOI:10.1186/1471-2288-14-45.
[8]包赞,邱炳辉,曾浩,等.万古霉素静脉联合鞘内途径治疗开颅术后颅内感染[J].中华危重病急救医学,2016,28(2):169-172.DOI:10.3760/cma.j.issn.2095-4352.2016.02.016.Bao Y,Qiu BH,Zeng H,et al.Combined intravenous and intrathecal vancomycin in treatment of patients with intracranial infections after craniotomy[J].Chinese Critical Care Medicine,2016,28(2):169-172.DOI:10.3760/cma.j.issn.2095-4352.2016.02.016.
[9]梁永平,马晓东,管清亮,等.万古霉素静脉及鞘内联合用药治疗开颅手术后颅内感染的临床观察[J].临床军医杂志,2011,39(2):269-271.DOI:10.3969/j.issn.1671-3826.2011.02.24.Liang YP,Ma XD,Guan QL,et al.Clinical effect on intravenous and intrathecal administration of vancomycin for postoperative intracranial infections[J].Clinical Journal of Medical Officers,2011,39(2):269-271.DOI:10.3969/j.issn.1671-3826.2011.02.24.
[10]陈献东,蔡建勇,巴华君,等.静脉与鞘内联合应用万古霉素治疗患者开颅术后颅内感染的疗效观察[J].中华医院感染学杂志,2016,26(7):1569-1571.DOI:10.11816/cn.ni.2016-152777.Chen XD,Cai JY,Ba HJ,et al.Efficacy of combined application of vancomycin in the treatment of intracranial infections after craniotomy[J].Chinese Journal of Nosocomiology,2016,26(7):1569-1571.DOI:10.11816/cn.ni.2016-152777.
[11]韩书清.万古霉素静脉及鞘内联合用药治疗开颅手术后颅内感染的临床观察[J].解放军预防医学杂志,2016,34(S1):150.DOI:10.13704/j.cnki.jyyx.2016.s1.130.Han SQ.Clinical efficacy observation of intravenous and intraventricular combine with intravenous of vancomycin in the treatment of intracranial infection after craniotomy[J].Journal of Preventive Medicine of Chinese People's Liberation Army,2016,34(S1):150.DOI:10.13704/j.cnki.jyyx.2016.s1.130.
[12]王婧,谷亮,张明,等.儿童颅底骨折合并颅内感染万古霉素鞘内注射联合静脉用药的疗效[J].江苏医药,2016,42(10):1168-1170.Wang J,Gu L,Zhang M,et al.Clinical efficacy observation of intravenous and intraventricular combine with intravenous of vancomycin in treatment of skull base fracture in children with intracranial infection[J].Jiangsu Medical Journal,2016,42(10):1168-1170.
[13]Popa D,Loewenstein L,Lam SW,et al.Therapeutic drug monitoring of cerebrospinal fluid vancomycin concentration duringintraventricular administration[J].J Hosp Infect,2016,92(2):199-202.DOI:10.1016/j.jhin.2015.10.017.
[14]Gilbert DN,Chambers HF,Eliopoulos GM,et al.桑福德抗微生物治疗指南[M].范洪伟,王焕玲,周宝桐,等,译.46版.北京:中国协和医科大学出版社,2017:107.Gilbert DN,Chambers HF,Eliopoulos GM,et al.The Sanford guide to antimicrobial therapy[M].Fan HW,Wang HL,Zhou BT,et al,translate.46th ed.Beijing:Peking Union Medical College Press,2017:107.
[15]Cohen SH,Gerding DN,Johnson S,et al.Clinical practice guidelines for Clostridium difficile infection in adults:2010 update by the societyfor healthcare epidemiology of America(SHEA)and the infectious diseases society of America(IDSA)[J].Infect Control Hosp Epidemiol,2010,31(5):431-455.DOI:10.1086/651706.
[16]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版)[EB/OL].(2015-07-24)[2017-10-18].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf.Revised group of guiding principle of clinical application ofantibacterials.Guiding principle of clinical application of antibacterials2015[EB/OL].(2015-07-24)[2017-10-18].http://www.nhfpc.gov.cn/ewebeditor/uploadfile/2015/09/20150928170007470.pdf.
[17]Schwabe M,Jttner E,Blaich A,et al.Cure of ventriculitis and central nervous system shunt infection by Staphylococcus epidermidis with vancomycin by inlraventricular injection in a liver transplant recipient[J].Transpl Infect Dis,2007,9(1):46-50.DOI:10.1111/j.1399-3062.2006.00157.x.
[18]Cao DM,Jiang JG,Wu YK.Effects of intrathecal injection of Vancomycin combined external drainage of lumbar cistern for treatment of intracranial infection[J].J Clin Neurosurg,2015,12(1):64-65.