阿米卡星联合抗假单胞菌β-内酰胺类抗菌药物经验性治疗医院获得性肺炎的系统评价
发布时间：2018-07-31 16:03
【摘要】：目的： 采用Cochrane系统评价方法对阿米卡星联合抗假单胞菌p-内酰胺类抗菌药物初始经验性治疗医院获得性肺炎(Hospital acquired pneumonia, HAP)的有效性和安全性进行评价。 方法： 按照Cochrane Collaboration的标准,计算机全面检索CENTRAL (Cochrane图书馆临床对照试验中心数据库,2012年第7期)、MEDLINE (1950～2012.11)、EMBASE (1980～2012.11)、中国生物医学文献数据库(CBM,1970～2012.11)、中国期刊网全文数据库(CNKI,1970～2012.11)、维普数据库(VIP,1970～2012.11)、会议资料及互联网资料,检索不限语种,收集阿米卡星联合抗假单胞菌β-内酰胺类抗菌药物经验性治疗HAP的临床随机对照实验(Randomized controlled trials, RCT)。由两名系统评价员独立筛选纳入的研究并评价偏倚风险,提取相关资料进行交叉核对,如有意见分歧可经讨论或由具有相关专业知识的第三入仲裁。采用治疗有效率、失败率、细菌学清除率、铜绿假单胞菌清除率、二重感染率、死亡率及不良反应发生率为结局指标对阿米卡星联合抗假单胞菌p-内酰胺类抗菌药物经验性治疗HAP的疗效和安全性进行评估。运用RevMan5.2软件对数据进行统计分析。 结果： 最终共纳入6个RCT,703例HAP患者。2个研究质量较高,4个研究质量较低。统计分析结果如下： 1.阿米卡星联合头孢他啶VS美罗培南单用：阿米卡星联合头孢他啶经验性治疗HAP的临床治疗失败率高于美罗培南,有统计学差异[RR=1.73,95%CI(1.01,2.98)]；在临床治疗有效率、细菌学清除率、铜绿假单胞菌清除率、二重感染率、死亡率、不良反应发生率方面两组无统计学差异(结果分别为RR=0.82,95％CI(0.67,1.01)；RR=0.82,95％CI(0.67,1.01)；RR=0.87,95％CI(0.58,1.31)；RR=1.12,95％CI(0.66,1.92)； RR=0.58,95％CI(0.14,2.35)；RR=1.21,95％CI(0.69,2.14)；RR=1.11,95％CI(0.43,2.90)). 2.阿米卡星联合抗假单胞菌B-内酰胺类菌药物VS喹诺酮类抗菌药物联合抗假单胞菌β-内酰胺类药物：阿米卡星联合抗假单胞菌β-内酰胺类菌药物经验性治疗HAP的细菌清除率优于喹诺酮类抗菌药物联用抗假单胞菌β-内酰胺类药物,有统计学意义[RR=1.34,95%CI(1.07,1.67)]；在铜绿假单胞菌清除率、二重感染率、死亡率方面两组无统计学差异(结果分别为RR=1.13,95％CI(0.74,1.73)；RR=1.05,95％CI(0.24,4.59)；RR=0.88,95％CI(0.55,1.43)). 3.阿米卡星联合头孢吡肟VS头孢吡肟单用：阿米卡星联合头孢吡肟经验性治疗HAP的临床有效率、细菌清除率优于头孢吡肟单用,有统计学差异(结果分别为RR=1.25,95％CI(1.09,1.45)；RR=l.32,95％CI(1.09,1.59)；失败率低于头孢吡肟单用,有统计学差异[RR=0.38,95%CI(0.20,0.72)]；在铜绿假单胞菌清除率、二重感染率、死亡率方面两组并无统计学差异(结果分别为RR=1.29,95％CI(0.9,1.72)；RR=3.16,95％CI(0.36,27.78)；RR=1.85,95％CI(0.37,9.18)). 结论： 本系统评价显示了阿米卡星联用抗假单胞菌p-内酰胺类菌药物经验性治疗HAP的有效性和安全性,所支持的证据质量级别低,为弱推荐。纳入的研究数量少,样本量小,且大部分研究方法学质量不高,需更多高质量大规模的RCT,应用证据时应谨慎。
[Abstract]:Objective:
The effectiveness and safety of the initial empirical treatment of hospital acquired pneumonia (Hospital acquired pneumonia, HAP) with Amikacin combined with anti Pseudomonas p- lactam antibiotics was evaluated by the Cochrane system evaluation method.
Method:
According to the standard of Cochrane Collaboration, the computer completely retrieves CENTRAL (Cochrane library clinical controlled trial center database, seventh period 2012), MEDLINE (1950 ~ 2012.11), EMBASE (1980 ~ 2012.11), Chinese biomedical literature database (CBM, 1970 to 2012.11), Chinese Journal Network full text database (CNKI, 1970 to 2012.11), VP number According to the library (VIP, 1970 ~ 2012.11), conference data and Internet data, retrieval of non limited languages, the clinical randomized controlled trial (Randomized controlled trials, RCT) for the empirical treatment of HAP for beta lactam antibiotics against Pseudomonas aeruginosa (Randomized trials, RCT) was collected and the risk of bias was evaluated by two independent evaluators. Cross check the relevant data, such as disagreement can be discussed or third into arbitration with relevant professional knowledge. Treatment efficiency, failure rate, bacteriological clearance rate, Pseudomonas aeruginosa clearance rate, double infection rate, mortality and adverse reaction rate are the outcome indicators of Amikacin combined with anti Pseudomonas p- The efficacy and safety of empirical treatment of HAP with lactam antibiotics were evaluated. RevMan 5.2 software was used to analyze the data.
Result:
Finally, a total of 6 RCT and 703 HAP patients were included in the study. The quality of.2 research was higher and the quality of the 4 studies was lower.
1. Amikacin combined with ceftazidime VS meropenem: the clinical treatment failure rate of Amikacin combined with ceftazidime was higher than meropenem, with a statistically significant difference of [RR=1.73,95%CI (1.01,2.98)]; in clinical treatment, bacteriological clearance rate, Pseudomonas aeruginosa clearance rate, double infection rate, mortality, and bad condition There were no statistical differences between the two groups (the results were RR=0.82,95%CI (0.67,1.01); RR=0.82,95%CI (0.67,1.01); RR=0.87,95%CI (0.58,1.31); RR=1.12,95%CI (0.66,1.92); RR=0.58,95%CI (0.14,2.35); RR=1.21,95%CI (0.69,2.14)).
2. Amikacin combined with Pseudomonas sp. B- lactam drugs VS quinolone antibiotics combined with Pseudomonas beta lactam: Amikacin combined with Pseudomonas beta lactam for the empirical treatment of HAP, the bacterial clearance rate is superior to quinolone antibiotics combined with Pseudomonas beta lactam drugs, Statistical significance [RR=1.34,95%CI (1.07,1.67)]; there were no statistical differences in the two groups of Pseudomonas aeruginosa clearance rate, double infection rate and mortality rate (RR=1.13,95%CI (0.74,1.73), RR=1.05,95%CI (0.24,4.59), RR=0.88,95%CI (0.55,1.43)).
3. Amikacin combined cefepime VS cefepime single use: the clinical efficacy of HAP combined with cefepime in combination with cefepime, the bacterial clearance rate is better than cefepime alone, with statistical differences (RR=1.25,95%CI (1.09,1.45) and RR=l.32,95%CI (1.09,1.59), respectively, and the failure rate is lower than cefepime alone. [RR=0.38,95%CI (0.20,0.72)); there were no statistical differences in the two groups of Pseudomonas aeruginosa clearance rate, double infection rate and mortality rate (RR=1.29,95%CI (0.9,1.72); RR=3.16,95%CI (0.36,27.78); RR=1.85,95%CI (0.37,9.18)).
Conclusion:
The systematic evaluation showed the effectiveness and safety of Amikacin combined with p- lactam drug for the treatment of HAP. The evidence supported by the drug was low in quality and weak recommendation. The number of studies included is small, the sample size is small, and most of the research methodology is not high, and more high quality and large-scale RCT is needed. When the evidence is applied, the evidence is applied. Be careful.
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R96;R563.1
本文编号：2156089
[Abstract]:Objective:
The effectiveness and safety of the initial empirical treatment of hospital acquired pneumonia (Hospital acquired pneumonia, HAP) with Amikacin combined with anti Pseudomonas p- lactam antibiotics was evaluated by the Cochrane system evaluation method.
Method:
According to the standard of Cochrane Collaboration, the computer completely retrieves CENTRAL (Cochrane library clinical controlled trial center database, seventh period 2012), MEDLINE (1950 ~ 2012.11), EMBASE (1980 ~ 2012.11), Chinese biomedical literature database (CBM, 1970 to 2012.11), Chinese Journal Network full text database (CNKI, 1970 to 2012.11), VP number According to the library (VIP, 1970 ~ 2012.11), conference data and Internet data, retrieval of non limited languages, the clinical randomized controlled trial (Randomized controlled trials, RCT) for the empirical treatment of HAP for beta lactam antibiotics against Pseudomonas aeruginosa (Randomized trials, RCT) was collected and the risk of bias was evaluated by two independent evaluators. Cross check the relevant data, such as disagreement can be discussed or third into arbitration with relevant professional knowledge. Treatment efficiency, failure rate, bacteriological clearance rate, Pseudomonas aeruginosa clearance rate, double infection rate, mortality and adverse reaction rate are the outcome indicators of Amikacin combined with anti Pseudomonas p- The efficacy and safety of empirical treatment of HAP with lactam antibiotics were evaluated. RevMan 5.2 software was used to analyze the data.
Result:
Finally, a total of 6 RCT and 703 HAP patients were included in the study. The quality of.2 research was higher and the quality of the 4 studies was lower.
1. Amikacin combined with ceftazidime VS meropenem: the clinical treatment failure rate of Amikacin combined with ceftazidime was higher than meropenem, with a statistically significant difference of [RR=1.73,95%CI (1.01,2.98)]; in clinical treatment, bacteriological clearance rate, Pseudomonas aeruginosa clearance rate, double infection rate, mortality, and bad condition There were no statistical differences between the two groups (the results were RR=0.82,95%CI (0.67,1.01); RR=0.82,95%CI (0.67,1.01); RR=0.87,95%CI (0.58,1.31); RR=1.12,95%CI (0.66,1.92); RR=0.58,95%CI (0.14,2.35); RR=1.21,95%CI (0.69,2.14)).
2. Amikacin combined with Pseudomonas sp. B- lactam drugs VS quinolone antibiotics combined with Pseudomonas beta lactam: Amikacin combined with Pseudomonas beta lactam for the empirical treatment of HAP, the bacterial clearance rate is superior to quinolone antibiotics combined with Pseudomonas beta lactam drugs, Statistical significance [RR=1.34,95%CI (1.07,1.67)]; there were no statistical differences in the two groups of Pseudomonas aeruginosa clearance rate, double infection rate and mortality rate (RR=1.13,95%CI (0.74,1.73), RR=1.05,95%CI (0.24,4.59), RR=0.88,95%CI (0.55,1.43)).
3. Amikacin combined cefepime VS cefepime single use: the clinical efficacy of HAP combined with cefepime in combination with cefepime, the bacterial clearance rate is better than cefepime alone, with statistical differences (RR=1.25,95%CI (1.09,1.45) and RR=l.32,95%CI (1.09,1.59), respectively, and the failure rate is lower than cefepime alone. [RR=0.38,95%CI (0.20,0.72)); there were no statistical differences in the two groups of Pseudomonas aeruginosa clearance rate, double infection rate and mortality rate (RR=1.29,95%CI (0.9,1.72); RR=3.16,95%CI (0.36,27.78); RR=1.85,95%CI (0.37,9.18)).
Conclusion:
The systematic evaluation showed the effectiveness and safety of Amikacin combined with p- lactam drug for the treatment of HAP. The evidence supported by the drug was low in quality and weak recommendation. The number of studies included is small, the sample size is small, and most of the research methodology is not high, and more high quality and large-scale RCT is needed. When the evidence is applied, the evidence is applied. Be careful.
【学位授予单位】：湖南师范大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R96;R563.1
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