Clinical effectiveness of carbapenems versus alternative antibiotics for treating ESBL-producing Enterobacteriaceae bacteraemia: a systematic review and meta-analysis.
J Antimicrob Chemother
; 73(10): 2631-2642, 2018 10 01.
Article
em En
| MEDLINE
| ID: mdl-29800480
ABSTRACT
Objectives:
The widespread administration of carbapenems to patients with ESBL-producing Enterobacteriaceae bacteraemia (ESBL-B) has accelerated the emergence of carbapenem-resistant Enterobacteriaceae. This study aimed to systematically review recently published data to evaluate the clinical effectiveness of carbapenems, compared with other antibiotics, in the treatment of ESBL-B.Methods:
We searched the Ovid-Medline, Ovid-Embase, Cochrane Library and five Korean local databases until January 2016. We selected studies that reported overall mortality in patients with ESBL-B who had been treated with carbapenems and alternatives. Overall mortality was assessed as the primary outcome and sepsis-related mortality and adverse events were analysed as secondary outcomes.Results:
Thirty-five publications fulfilled the inclusion criteria. Regarding empirical therapy, there were no significant differences between the groups that received carbapenems and those that received non-carbapenems in relation to overall mortality. Regarding definitive therapy, overall mortality was lower for patients administered carbapenems compared with those administered non-carbapenems [risk ratio (RR) 0.78, 95% CI 0.61-0.98], non-ß-lactam/ß-lactamase inhibitor combinations (non-BL/BLI) (RR 0.71, 95% CI 0.56-0.90) and cephalosporins (RR 0.56, 95% CI 0.42-0.74). There were no differences between the carbapenems and the other antibiotics, namely BL/BLIs, quinolones and aminoglycosides.Conclusions:
This meta-analysis showed that BL/BLIs may be promising alternative antibiotics for definitive therapy in patients with ESBL-B. However, the lack of robust data derived from randomized controlled trials limits the conclusions and inferences from the pooled data.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Carbapenêmicos
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Bacteriemia
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Enterobacteriaceae
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Infecções por Enterobacteriaceae
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Antibacterianos
Tipo de estudo:
Clinical_trials
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Systematic_reviews
Limite:
Humans
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article