头孢他啶/阿维巴坦
阿兹屈南
头孢他啶
荟萃分析
碳青霉烯
粘菌素
微生物学
置信区间
医学
内科学
多粘菌素
相对风险
抗生素
重症监护医学
生物
细菌
铜绿假单胞菌
抗生素耐药性
亚胺培南
遗传学
作者
Nitin Gupta,Carl Boodman,Parikshit Prayag,Abi Manesh,Praveen Kumar Tirlangi
标识
DOI:10.1080/14787210.2024.2307912
摘要
Carbapenem-resistant Enterobacterales (CRE) due to Metallo-β-lactamase (MBL) production are treated with either polymyxins or the novel combination of ceftazidime-avibactam and aztreonam (AA). This study aims to evaluate the 30-day mortality of AA in patients with BSI caused by MBL-CRE infections.In this systematic review and meta-analysis, all articles up to June 2023 were screened using search terms like 'CRE', 'MBL', 'AA' and 'polymyxins'. The risk ratio for AA vs polymyxins was pooled using a random-effect model, and the results were represented by a point estimate with a 95% confidence interval.After removing the duplicates, the titles and abstracts of 455 articles were screened, followed by a full-text screening of 50 articles. A total of 24 articles were included for systematic review, and four comparative studies were included in the meta-analysis. All four studies had a moderate or serious risk of bias. The pooled risk ratio for 30-day mortality for AA vs. polymyxins was 0.51 (95%CI: 0.34-0.76), p < 0.001. There was no significant heterogeneity.The meta-analysis from studies with a high risk of bias shows that AA is associated with lesser 30-day mortality when compared to polymyxins in patients with MBL-producing CRE BSI. Registration with PROSPERO- CRD42023433608.
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