在无并发格兰阴性细菌病中过渡到口服β-乳酸治疗:系统性审查和元分析
Michael Dore1,2,3, Ryan Duffy1,2, Laura Caputo1,2
1Durham Veteran's Affairs Medical Center, Durham, North Carolina, USA.
Journal of hospital medicine
|April 4, 2025
概括
过渡到口服β-乳糖抗生素治疗阴性细菌病 (GNB) 是安全和有效的,因为传统的诺基诺或三甲-硫. 这次元分析没有发现死亡率或治疗失败率的显著差异.
科学领域:
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
- 临床医学 临床医学
背景情况:
- 格拉姆阴性细菌病 (GNB) 具有显著的患者发病率和死亡率风险.
- 目前的指导方针有利于诺基诺或trimethoprim-sulfamethoxazole进行口服转换,这是由于对beta-lactams的可感知药物动力学优势.
- 支持这种偏好的临床数据有限.
研究的目的:
- 评估过渡到口服β-乳酸 (BL) 治疗的临床疗效,以治疗不复杂的GNB.
- 在患者结局方面,将BL与诺基诺/三甲-硫甲 (FQ/TMP-SMX) 进行比较.
主要方法:
- 进行了八项回顾性队列研究的元分析,其中包括没有并发症的GNB的成年患者.
- 数据来源于 MEDLINE,Embase 和 Web of Science 数据库,截至 2024 年 9 月.
- 评估的主要结局是30天全因死亡率和30天抗生素失效率.
主要成果:
- 分析包括7500名患者,其中FQ/TMP-SMX组有4998名,BL组有2482名.
- 患者人口统计和临床特征在各组之间相似.
- 在30天全因死亡率 (2.06%对1.89%) 或30天抗生素失败率 (2.08%对3.42%) 中,两种治疗方法之间没有观察到统计学上显著的差异.
结论:
- 口服β-乳糖胺是一种可行的和有效的选择,用于在不复杂的GNB中过渡治疗.
- 在比较口服BL与FQ/TMP-SMX时,30天死亡率或抗生素失败率没有统计学上显著的差异.
- 这些发现挑战了传统的治疗偏好,并支持口服β-乳酸盐的使用.
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