抗菌药物降阶梯疗法对肺炎患者临床结局影响的Meta分析
发布时间：2018-11-08 15:23
【摘要】：目的探讨抗菌药物降阶梯疗法对肺炎患者临床结局的影响,为临床治疗提供参考依据。方法检索数据库收集2016年6月之前发表的所有相关研究,共纳入13篇研究,研究对象共计4 768例,包括抗菌药物降阶梯组1 221例和持续性经验抗菌药物组3547例;采用Stata 12.0软件进行异质性检验、计算RR值及其95%CI可信区间。结果与持续性经验抗菌药物治疗比较,抗菌药物降阶梯组可降低肺炎患者的病死率,且差异有统计学意义(P0.01),尤其是在呼吸机相关肺炎和社区获得性肺炎患者中差异显著;而包含两项随机对照试验研究的汇总分析则显示,抗菌药物降阶梯治疗增加肺炎患者的病死率,但差异无统计学意义。结论与持续性经验抗菌药物治疗比较,抗菌药物降阶梯疗法可降低呼吸机相关肺炎和社区获得性肺炎患者病死率;但仍需要精心设计的随机对照试验评估抗菌药物降阶梯疗法对细菌生态系统、多药耐药情况以及患者临床结局的影响。
[Abstract]:Objective to investigate the effect of antibacterials descending ladder therapy on the clinical outcome of patients with pneumonia and to provide reference for clinical treatment. Methods all the related studies published before June 2016 were collected and 13 studies were included in the database. A total of 4 768 subjects were included in the study, including 1 221 cases in the antibacterials descending ladder group and 3547 cases in the persistent experience group. Stata 12.0 software was used to test the heterogeneity, and the RR value and its 95%CI confidence interval were calculated. Results compared with the continuous experience antibiotic therapy, the mortality of pneumonia patients was significantly decreased in the antibacterials descending ladder group (P0.01), and there was no significant difference between the two groups (P0.01). There was significant difference between ventilator-associated pneumonia and community-acquired pneumonia. The summary analysis including two randomized controlled trials showed that the mortality of pneumonia patients was increased by the step down treatment of antimicrobial agents, but the difference was not statistically significant. Conclusion compared with the continuous experience of antimicrobial therapy, the mortality of patients with ventilator-associated pneumonia and community-acquired pneumonia can be reduced by the step therapy of antimicrobial agents. However, carefully designed randomized controlled trials are still needed to assess the impact of antibacteriological ladder therapy on bacterial ecosystems, multidrug resistance and clinical outcomes.
【作者单位】： 常州市第四人民医院感染管理科;常州市第四人民医院药剂科;常州市第四人民医院呼吸内科;
【基金】：江苏省常州四药临床药学科研基金资助项目(2015277)
【分类号】：R563.1
[Abstract]:Objective to investigate the effect of antibacterials descending ladder therapy on the clinical outcome of patients with pneumonia and to provide reference for clinical treatment. Methods all the related studies published before June 2016 were collected and 13 studies were included in the database. A total of 4 768 subjects were included in the study, including 1 221 cases in the antibacterials descending ladder group and 3547 cases in the persistent experience group. Stata 12.0 software was used to test the heterogeneity, and the RR value and its 95%CI confidence interval were calculated. Results compared with the continuous experience antibiotic therapy, the mortality of pneumonia patients was significantly decreased in the antibacterials descending ladder group (P0.01), and there was no significant difference between the two groups (P0.01). There was significant difference between ventilator-associated pneumonia and community-acquired pneumonia. The summary analysis including two randomized controlled trials showed that the mortality of pneumonia patients was increased by the step down treatment of antimicrobial agents, but the difference was not statistically significant. Conclusion compared with the continuous experience of antimicrobial therapy, the mortality of patients with ventilator-associated pneumonia and community-acquired pneumonia can be reduced by the step therapy of antimicrobial agents. However, carefully designed randomized controlled trials are still needed to assess the impact of antibacteriological ladder therapy on bacterial ecosystems, multidrug resistance and clinical outcomes.
【作者单位】： 常州市第四人民医院感染管理科;常州市第四人民医院药剂科;常州市第四人民医院呼吸内科;
【基金】：江苏省常州四药临床药学科研基金资助项目(2015277)
【分类号】：R563.1
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