替加环素联合治疗鲍曼不动杆菌感染疗效的Meta分析

Tigecycline combined conventional treatment for Acinetobacter baumannii infections: A Meta analysis

目的系统评价替加环素联合治疗鲍曼不动杆菌感染的疗效与安全性。方法计算机检索Cochrane图书馆、EmBase、PubMed、Web of Science、中国期刊全文数据库(CNKI)、中国生物医学文献数据库(CBM)、中文科技期刊全文数据库(VIP)和万方数据库(检索时间均从建库至2016年7月)关于替加环素联合治疗鲍曼不动杆菌的随机对照试验、队列研究。由2名研究者按入选与排除标准独立筛选试验,并对纳入研究的方法学质量进行评价,提取资料;用RevMan5.14软件对数据进行Meta分析。结果共纳入12篇随机对照研究,5篇高质量的队列研究,共涉及1908例病例,其中试验组(替加环素联合治疗组)992例,对照组(其他抗鲍曼不动杆菌药物治疗组)916例。Meta分析结果显示:试验组临床有效率优于对照组,差异有统计学意义(P<0.05);试验组与对照组在微生物清除率、30 d死亡率方面差异均无统计学意义(P>0.05)。结论基于现有临床证据,替加环素联合治疗鲍曼不动杆菌感染,临床有效,但对于微生物清除及30 d死亡率的影响并不优于其他常规的药物治疗组。由于纳入研究数量较少,研究质量不统一,本结论还需要更多大样本、高质量临床随机对照试验予以验证。

Objective To evaluate the efficacy and safety of tigecycline conventional treatment for Acinetobacter baumannii infections. Methods We searched the Cochrane Library, EmBase, PubMed, CBM, CNKI and VIP （from inception to July 2016） for randomized controlled trials （RCTs） and Cohort study of tigecycline combined conventional treatment for Acinetobacter baumannii infections. Two reviewers independently retrieved RCTs according to the inclusion and exclusion criteria, assessed the methodological quality of included trials, and extracted data. The data analysis was performed by RevMan 5.14 software. Results Totally twelve RCTs and five cohort study involving 1908 patients were ultimately identified, including 992 cases accepted tigecycline based regime （treatment group）, other 916 cases accepted other anti- Acinetobacter baumannii antibiotic regime （control group）. The results of Meta - analyses showed that effective rate in treatment group was superior to control group, with significant differences （P 〈0.05）. Microbiological eradication rate and mortality in 30 d in treatment group were similar to control group, with no significant difference （P 〉 0. 05 ）. Conclusion The results of Metaanalyses indicate that tigecycline combined conventional treatment for Acinetobacter baumannii infections is effective. Howerver, due to the number and quality of included studies, more large sample size, high - quality RCTs are needed.