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利法基治疗与黄金葡萄球菌原生脊椎骨髓炎患者:一个系统性审查和元分析
Said El Zein1, Elie F Berbari1, Matteo Passerini2
1Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
概括
基于里法的治疗可能会减少黄金葡萄球菌脊椎骨质炎 (NVO) 的治疗失败. 然而,非常低的确定性证据意味着需要更多的研究,比如随机试验,来证实这些发现.
科学领域:
- 传染性疾病 传染性疾病
- 整形外科手术 整形外科手术
- 药理学 药理学是指药理学的学科.
背景情况:
- 由黄金葡萄球菌引起的原生脊椎骨髓炎 (NVO) 由于高治疗失败率和发病率而构成重大挑战.
- 含有里法的治疗方案对S. aureus NVO的疗效仍然是医学界争论的主题.
研究的目的:
- 系统地审查并对基于里法的疗法治疗S. aureus NVO的疗效和安全性进行元分析.
- 评估里法素对S. aureus NVO.患者临床失败率的影响.
主要方法:
- 在主要数据库 (Cochrane,Embase,Medline,Scopus,Web of Science) 进行了全面的文献搜索,截至2023年5月.
- 包括的研究集中在成年NVO患者中,这些患者接受了与里法治疗或不接受治疗,使用随机效应模型对相对风险和风险差异进行了元分析.
主要成果:
- 对13项研究 (2项RCT,11项队列研究) 的分析,涉及244名接受里法素治疗的患者和435名对照患者,表明基于里法素的治疗方案具有较低的临床失败风险 (RD, -14%;P<.001).
- 临床失败的相对风险为0.58 (95% CI, .37-.92; P = .02).
- 所有纳入的研究都显示出高或不确定的偏差风险,证据的整体确定性被评为非常低.
结论:
- 辅助里法胺治疗显示出减少S. aureus NVO治疗失败的潜力.
- 目前的证据的确定性非常低,不允许对临床实践的变化做出最终结论.
- 进一步高质量的随机对照试验对于验证这些初步发现至关重要.
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