哌拉西林他唑巴坦联合喹诺酮类药物治疗非重症下呼吸道感染的有效性和安全性的Meta分析

Meta-analysis of the efficacy and safety of piperacillin-tazobactam plus fluoroquinolones in the treatment of non-critical patients with lower respiratory tract infections

中、英文数据库:中国知网(CNKI)、万方(WanFang)、维普(VIP)、中国生物医学文献库(CBM)、The Cochrane Library、PubMed、Embase、WebofScience,检索内容为使用哌拉西林他唑巴坦联合喹酮类药物治疗非重症下呼吸道感染的随机对照试验(RCT),检索时间为从建库起至2023年4月。分别采用RevMan5.4软件和Stata 18.0软件进行Meta分析和敏感性分析。结果共纳入14项RCT,共1116例患者。Meta分析结果显示,与单用哌拉西林他唑巴坦比较,哌拉西林他唑巴坦联合喹诺酮类药物治疗非重症下呼吸道感染可提高治疗有效率[OR=4.77,95%CI(3.04~7.49),Z=6.79,P<0.00001]、缩短咳嗽持续时间[OR=-2.08,95%CI(-3.43~-0.72),Z=3.01,P=0.003]、缩短体温恢复时间[OR=-2.14,95%CI(-2.83~-1.45),Z=6.05,P<0.00001]、缩短X线胸片病灶吸收时间[OR=-2.28,95%CI(-3.50~-1.06),Z=3.66,P=0.0003]、降低C反应蛋白水平[OR=6.48,95%CI(0.59~12.36),Z=2.16,P=0.03]、提高细菌清除率[OR=4.51,95%CI(2.00~10.16),Z=3.64,P=0.0003]。在白细胞计数和不良反应方面,2组差异无统计学意义(P>0.05)。结论哌拉西林他唑巴坦联合喹诺酮类药物治疗非重症下呼吸道感染可提高治疗有效率、改善症状且不增加不良反应,但仍需要更多高质量、大样本的RCT证据支持。

AIM To systematically review the validity and safety of piperacillin-tazobactam plus fluoroquinolones in the therapy of non-critical patients with lower respiratory tract infections.METHODS The foreign databases including the Cochrane Library,PubMed,Embase,Web of Science,and Chinese databases including CNKI,WanFang,VIP,and CBM were searched to collect randomized controlled trials(RCTs)involving the comparison of piperacillin-tazobactam monotherapy with piperacillin-tazobactam plus fluoroquinolones for the treatment of non-critical patients with lower respiratory tract infections up to April 2023.The Meta-analysis and sensitivity analysis were conducted using the RevMan 5.4 and Stata 18.0 software respectively.RESULTS 14 RCTs involving 1116 patients were included.The Meta-analysis results indicated that the fluoroquinolones plus piperacillin-tazobactam could improve treatment efficacy[OR=4.77,95%CI(3.04-7.49),Z=6.79,P<0.00001],shorten cough relief time[OR=-2.08,95%CI(-3.43--0.72),Z=3.01,P=0.003],shorten body temperature recovery time[OR=-2.14,95%CI(-2.83--1.45),Z=6.05,P<0.00001],shorten lesions absorption time[OR=-2.28,95%CI(-3.50--1.06),Z=3.66,P=0.0003],effectively lower C-reactive protein(CRP)level[OR=6.48,95%CI(0.59-12.36),Z=2.16,P=0.03],and improve bacterial clearance rate[OR=4.51,95%CI(2.00-10.16),Z=3.64,P=0.0003]compared to piperacillin-tazobactam monotherapy.There was no significant difference in the decrease in levels of white blood cell and adverse drug reactions between 2 groups(P>0.05).CONCLUSION Piperacillin-tazobactam plus fluoroquinolones could improve clinical efficacy,alleviate symptoms,and show good safety in the treatment of non-critical patients with lower respiratory tract infections.However,due to the difference in methodological quality,a small sample size,and more high-quality and large-sample RCTs evidence support is still needed.