结合抗生素对耐药性的影响:系统性审查和元分析
Berit Siedentop1,2, Viacheslav N Kachalov2,3, Christopher Witzany1
1Institute of Integrative Biology, Department of Environmental Systems Science, ETH Zürich, Zurich, Switzerland.
medRxiv : the preprint server for health sciences
|July 28, 2023
概括
抗生素组合疗法是一种抗生素组合疗法.
科学领域:
- 医学微生物学 医学微生物学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 抗生素耐药性是一个日益增长的全球健康威胁.
- 联合抗生素治疗在抗药性演变中的作用尚不清楚.
- 了解抗生素组合如何影响耐药性对于有效的治疗策略至关重要.
研究的目的:
- 研究抗生素联合治疗对患者抗生素耐药性发展的影响.
- 综合来自随机对照试验 (RCT) 关于不同抗生素治疗方案下的耐药性发展的证据.
主要方法:
- 对 (准) 随机对照试验 (RCT) 的系统审查和元分析.
- 在 2022 年 11 月 24 日之前搜索了 CENTRAL,EMBASE 和 PubMed 数据库.
- 包括比较不同数量的抗生素的试验;通过培养评估了耐药性的获得.
- 使用随机效应模型,元回归和分层分析分析数据;评估偏差风险.
主要成果:
- 29个涉及5054名患者的RCT被纳入了元分析.
- 使用更多抗生素获得耐药性的概率比率是1.23 (95% CI 0.68-2.25),表明存在相当大的异质性 (I2=77%).
- 有证据表明,对特定的病原体/疾病有潜在的有益或有害影响,但总体发现是不确定的,并且与益处和危害兼容.
结论:
- 关于抗生素联合治疗对抗药性影响的RCT目前的证据有限且异质.
- 使用更多抗生素而不是更少的抗生素的效果是不确定的,可能会带来好处或危害.
- 需要进一步进行高功率的RCT或精心设计的观察性研究,以澄清组合治疗对抗药性演变的确切影响.
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