头孢他啶/阿维巴坦治疗复杂性尿路感染疗效和安全性的Meta分析

Meta-analysis of efficacy and safety of ceftazidime/avibactam in the treatment of complex urinary tract infection

目的 采用Meta分析法评价头孢他啶/阿维巴坦(CAZ/AVI)治疗复杂性尿路感染的疗效和安全性,为临床合理用药提供循证参考。方法 利用计算机检索PubMed、Embase、Web of Science、Cochrane Library英文数据库,中国知网、万方数据知识服务平台、维普网中文数据库,并补充检索临床试验注册库U.S.National Library of Medicine、中国临床试验注册中心截至2022年5月的文献,共纳入CAZ/AVI与其他抗感染治疗的随机对照试验5篇,并采用RevMan 5.3统计软件进行分析。结果 CAZ/AVI组与对照组临床治愈率比较差异无统计学意义[RR=1.01,95%CI(0.99,1.03),P=0.34)]。CAZ/AVI组细菌清除率高于对照组[RR=1.14,95%CI(1.09,1.20),P=0.000 01]。CAZ/AVI组不良事件发生率低于对照组,但差异无统计学意义[RR=0.76,95%CI(0.57,1.02),P=0.07],其严重不良事件发生率高于对照组,但差异无统计学意义[RR=1.82,95%CI(0.88,3.75),P=0.10]。结论 CAZ/AVI在治疗复杂性尿路感染方面并不逊于其他现有抗生素,尤其在细菌清除率方面有较好效果,CAZ/AVI不良事件发生率低,但严重不良事件发生率稍高于其他抗感染方案。

Objective To evaluate the efficacy and safety of ceftazidime/avibactam(CAZ/AVI) in the treatment of complex urinary tract infection by Meta-analysis method,providing evidence-based reference for clinical rational drug use.Methods To search the literatures of PubMed,Embase,Web of Science,Cochrane Library English databases,CNKI,Wanfang Data,WIP Chinese database,In addition,the U.S.National Library of Medicine and the Chinese Clinical Trials Registry supplemented as of May 2022 by computer,and a total of 5 literatures of randomized controlled trials of CAZ/AVI and other anti-infective treatments were included,and the analysis was carried out using RevMan 5.3 statistical software.Results There was no significant difference in clinical cure rate between CAZ/AVI group and control group [RR=1.01,95%CI(0.99,1.03),P=0.34].The bacterial clearance rate in CAZ/AVI group was higher than that in control group[RR=1.14,95%CI(1.09,1.20),P=0.000 01].The incidence of adverse events in CAZ/AVI group was lower than that in control group,but the difference was not statistically significant[RR=0.76,95%CI(0.57,1.02),P=0.07],and the incidence of serious adverse events was higher than that in control group.However,the difference was not statistically significant[RR=1.82,95%CI(0.88,3.75),P=0.10].Conclusion CAZ/AVI is not inferior to other existing antibiotics in the treatment of complex urinary tract infection,especially in the bacterial clearance rate,CAZ/AVI has a low incidence of adverse events,but the incidence of serious adverse events is slightly higher than other anti-infection protocol.