医学
呼吸机相关性肺炎
肺炎
重症监护医学
荟萃分析
养生
随机对照试验
抗生素
医院获得性肺炎
内科学
微生物学
生物
作者
Maryam Ghadimi,Reed Siemieniuk,Stefan Schandelmaier,Mark Loeb,Afeez Abiola Hazzan,Danial Aminaei,Huda Gomaa,Ying Wang,Liang Yao,Arnav Agarwal,John Basmaji,Adrian Grant,William S.H. Kim,Giancarlo Alvarado‐Gamarra,В. В. Лихванцев,João Pedro Lima,Shahrzad Motaghi,Rachel Couban,Behnam Sadeghirad,Romina Brignardello‐Petersen
标识
DOI:10.1016/j.cmi.2024.05.017
摘要
BackgroundThe optimal empiric antibiotic regimen for non-ventilator-associated hospital-acquired pneumonia (HAP) is uncertain.ObjectivesTo compare alternative empiric antibiotic regimens in HAP using a network meta-analysis (NMA).MethodsData sources: Medline, EMBASE, Cochrane CENTRAL, Web of Science, and CINAHL from database inception to July 06, 2023.Study eligibility criteriaRandomized controlled trials (RCT).ParticipantsAdults with clinical suspicion of HAP.InterventionAny empiric antibiotic regimen versus another, placebo, or no treatment.Assessment of risk of biasPaired reviewers independently assessed risk of bias using a modified Cochrane tool for assessing risk of bias in randomized trials.Methods of data analysisPaired reviewers independently extracted data on trial and patient characteristics, antibiotic regimens, and outcomes of interest. We conducted frequentist random-effects NMAs for treatment failure and all-cause mortality and assessed the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Results39 trials proved eligible. 30 RCTs involving 4,807 participants found low certainty evidence that piperacillin-tazobactam (RR compared to all cephalosporins: 0.65; 95% CI: 0.42, 1.01) and carbapenems (RR compared to all cephalosporins: 0.77; 95% CI: 0.53, 1.11) might be among the most effective in reducing treatment failure. The findings were robust to the secondary analysis comparing piperacillin-tazobactam vs antipseudomonal cephalosporins or antipseudomonal carbapenems vs antipseudomonal cephalosporins. 11 RCTs involving 2,531 participants found low certainty evidence that ceftazidime and linezolid combination may not be convincingly different from cephalosporin alone in reducing all-cause mortality. Evidence on other antibiotic regimens is very uncertain. Data on other patient-important outcomes including adverse events was sparse, and we did not perform network or pairwise meta-analysis.ConclusionsFor empiric antibiotic therapy of adults with HAP, piperacillin-tazobactam might be among the most effective in reducing treatment failure in HAP. Empiric MRSA coverage may not exert additional benefit in reducing mortality in HAP.RegistrationPROSPERO (CRD 42022297224)
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