雾化阿米卡星辅助治疗多重耐药革兰阴性菌肺炎疗效与安全性的Meta分析
Meta analysis of efficacy and safety of amikacin nebulization as adjuvant therapy for multi-drug resistant Gram-negative bacteria pneumonia
张翔云 1焦伟杰 1王腾飞 2杜蕾1
作者信息
- 1. 河南省中医院(河南中医药大学第二附属医院)药学部,郑州 450003
- 2. 河南省中医院(河南中医药大学第二附属医院)急诊科,郑州 450003
- 折叠
摘要
目的 系统评价雾化阿米卡星(amikacin nebulization,AN)辅助治疗多重耐药革兰阴性菌肺炎(multi-drug resistant gram-negative bacteria pneumonia,MDR-GNBP)的疗效与安全性.方法 计算机检索数据库,按照纳入与排除标准纳入关于AN辅助治疗MDR-GNBP的随机对照试验(randomized controlled trials,RCT),并采用Review Manager 5.4和Stata SE 12.0软件进行Meta分析.结果 纳入9篇(10RCT研究)关于AN辅助治疗MDR-GNBP的文献,包含1302例患者.Meta分析的结果显示:在有效性方面,AN可提高MDR-GNBP患者的临床治愈率[RR=1.27(95％CI=1.03～1.58),P=0.03],尤其是呼吸机相关性肺炎患者的临床治愈率[RR=1.75(95％CI=1.21～2.53),P=0.003].另外,AN可提高MDR-GNBP患者的微生物清除率[RR=1.34(95％CI=1.09～1.66),P=0.005],缩短ICU停留时间[WMD=-2.23(95％CI=-3.79～-0.66),P=0.005],但不能降低全因死亡率[RR=1.01(95％CI=0.78～1.31),P=0.96]和肺炎相关死亡率[RR=1.09(95％CI=0.77～1.53),P=0.64].在安全性方面,AN不增加MDR-GNBP患者的不良反应发生率[RR=1.01(95％CI=0.95～1.09),P=0.68]、肾损伤发生率[RR=0.74(95％CI=0.52～1.05),P=0.09],但会增加呼吸道痉挛的发生率[RR=2.50(95％CI=1.12～5.56),P=0.02].结论 AN辅助治疗MDR-GNBP有一定优势,可作为一种新的治疗选择,但仍需大规模、多中心的RCT来验证.
Abstract
Objective This study aimed to evaluate the efficacy and safety of amikacin nebulization(AN)as adjuvant therapy for multi-drug-resistant Gram-negative bacteria pneumonia(MDR-GNBP).Methods The published randomized controlled trials(RCTs)of AN as adjuvant therapy for MDR-GNBP were searched by extracting data from clinical studies that met the inclusion and exclusion criteria,which were analyzed by Review Manager 5.4 and Stata SE 12.0 software.Results A total of 9 articles(10 RCTs)involving 1302 patients were included.The results of the Meta-analysis showed that in terms of effectiveness,AN adjuvant therapy could improve the clinical cure rate of MDR-GNBP patients[RR=1.27(95％CI=1.03～1.58),P=0.03],especially in ventilator-associated pneumonia patients[RR=1.75(95％CI=1.21～2.53),P=0.003].In addition,it could also improve the patient's microbial clearance rate[RR=1.34(95％CI=1.09～1.66),P=0.005],shorten the ICU stay time[WMD=-2.23(95％CI=-3.79～0.66),P=0.005],but could not reduce the all-cause mortality rate[RR=1.01(95％CI=0.78～1.31),P=0.96]or pneumonia-related mortality rate[RR=1.09(95％CI=0.77～1.53),P=0.64].In terms of safety,AN did not increase the incidence rate of adverse reactions in patients[RR=1.01(95％CI=0.95～1.09),P=0.68],or the incidence rate of kidney injury[RR=0.74(95％CI=0.52～1.05),P=0.09],but it did increase the incidence rate of respiratory spasm[RR=2.50(95％CI=1.12～5.56),P=0.02].Conclusion AN as adjuvant therapy for MDR-GNBP had certain advantages and could be used as a new treatment option,but it still required a large-scale and multicenter RCT to verify.
关键词
阿米卡星/雾化吸入/多重耐药/革兰阴性菌/Meta分析Key words
Amikacin/Nebulization/Multi-drug resistant/Gram-negative bacteria/Meta-analysis引用本文复制引用
基金项目
河南省中医药科学研究专项课题(20-21ZY2213)
河南省中医药拔尖人才培养项目资助(豫卫中医函[2021]15号)
河南省中医院(河南中医药大学第二附属医院)院级科研项目(2017YJKT04)
出版年
2024
NETL
NSTL
万方数据