临床试验:持续或间歇的梅洛在患有败血症的重症患者中使用
Giacomo Monti1,2, Nikola Bradic3,4, Matteo Marzaroli1
1Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
JAMA
|June 16, 2023
概括
持续输注梅洛并没有改善严重性败血症患者的治疗结果. 与间歇剂量相比,这种抗生素给药方法没有降低死亡率或耐药细菌的出现.
科学领域:
- 传染性疾病
- 危急护理医学
- 药学动力学
背景情况:
- 梅洛是一种宽谱β- 乳酸抗生素,对治疗严重感染至关重要.
- 通过持续输注,保持药物度高于最低抑制度,可以达到最佳的美罗疗效.
- 连续输注可能比间歇性输注在危急患者中具有临床优势.
研究的目的:
- 在重症败血症患者中比较连续和间歇服用梅罗的疗效.
- 评估对死亡率和抗药性或广泛抗药性细菌的综合结果的影响.
- 评估二次结果,包括活着且没有使用抗生素或重症监护的日期.
主要方法:
- 这是一项双盲随机临床试验,涉及4个国家607名患有败血症或败血性休克的重症患者.
- 患者通过连续输注 (n=303) 或间歇输注 (n=304) 接受梅洛.
- 主要结局是所有原因死亡率和28日耐药细菌的出现.
主要成果:
- 主要综合结果发生在连续组的47%和间歇组的49% (RR,0.96;P=.60),没有显著差异.
- 在任何四个次要结果中都没有观察到统计学意义上的差异.
- 在连续和间歇治疗组中,90天死亡率为42%.
结论:
- 连续服用梅洛对于降低严重性败血症患者的死亡率或抗药性细菌的出现,与间歇性服用相比没有优势.
- 这些发现表明,目前的间歇性剂量策略仍然是对该患者群体的可行选择.
- 可能需要进一步的研究来确定可能受益于连续注射梅罗的特定患者子组.
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