摘要
目的探讨抗菌药物降阶梯疗法对肺炎患者临床结局的影响,为临床治疗提供参考依据。方法检索数据库收集2016年6月之前发表的所有相关研究,共纳入13篇研究,研究对象共计4 768例,包括抗菌药物降阶梯组1 221例和持续性经验抗菌药物组3547例;采用Stata 12.0软件进行异质性检验、计算RR值及其95%CI可信区间。结果与持续性经验抗菌药物治疗比较,抗菌药物降阶梯组可降低肺炎患者的病死率,且差异有统计学意义(P<0.01),尤其是在呼吸机相关肺炎和社区获得性肺炎患者中差异显著;而包含两项随机对照试验研究的汇总分析则显示,抗菌药物降阶梯治疗增加肺炎患者的病死率,但差异无统计学意义。结论与持续性经验抗菌药物治疗比较,抗菌药物降阶梯疗法可降低呼吸机相关肺炎和社区获得性肺炎患者病死率;但仍需要精心设计的随机对照试验评估抗菌药物降阶梯疗法对细菌生态系统、多药耐药情况以及患者临床结局的影响。
OBJECTIVE To evaluate the impact of antibiotic de-escalation therapy on clinical outcomes in patients with pneumonia,so as to provide references for clinical treatment.METHODS A search of databases up to Jun.2016 for relevant studies was performed.A total of 13 studies involving 4768 patients were included in the study,including 1221 cases of antibiotic de-escalation group and 3547 cases of continuation empirical antibiotic group.A heterogeneity test was conducted and the RR value and its 95% confidence interval （CI） were calculated by using Stata 12.0.RESULTS Our meta-analysis showed that compared with continuation empirical antibiotic group,the antibiotic de escalation group could reduce the mortality of patients with pneumonia,and the difference was significant （P〈0.01）,especially in the patients with ventilator-associated pneumonia and community-acquired pneumonia.However,pooling of two randomized controlled trials （RCTs） showed increased mortality with de-escalation without significance.CONCLUSION Compared with continuation empirical antibiotic therapy,antibiotic de-escala tion therapy can reduce the mortality in patients with ventilator-associated pneumonia and community-acquired pneumonia.But well-designed RCTs are still required to evaluate the effects of antibiotic de-escalation strategy on the bacterial ecosystem,multi-drug resistant carriage and patients outcomes.
作者
张培金
闵琦芬
刘协萍
张明珠
顾中秋
ZHANG Pei-jin MIN Qi-fen LIU Xie-ping ZHANG Ming-zhu GU Zhong-qiu(Changzhou Fourth People＇s Hospital, Changzhou, Jiangsu 213032, China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2017年第12期2686-2690,共5页
Chinese Journal of Nosocomiology
基金
江苏省常州四药临床药学科研基金资助项目(2015277)
