替加环素联合舒巴坦制剂治疗鲍曼不动杆菌感染的meta分析

Efficacy of Tigecycline Combined with Sulbactam to Acinetobacter Baumannii Infection: A Meta-analysis

关键词:  替加环素  舒巴坦  鲍曼不动杆菌  meta分析

Key words:  tigacycline  sulbactam  Acinetobacter baumannii  meta analysis

摘要:

目的 系统评价替加环素联合舒巴坦制剂治疗多重耐药/泛耐药鲍曼不动杆菌感染的疗效。方法 系统检索CNKI、Wangfang Data、CBM、PubMed、The Cochrane Library、Web of science、Embase，检索时间为建库至2018年7月1日，检索方式为主题词结合自由词检索，语种不限，由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用RevMan 5.3软件进行meta分析。结果 检索到相关文献共1 062篇，按纳入及排除标准从中选择符合标准的46篇文献。Meta分析结果显示，替加环素联合舒巴坦制剂对比单用替加环素或单用舒巴坦制剂在总的有效率和细菌清除率方面有一定优势[OR=3.90，95%CI（3.25，4.68），P<0.000 01]，[OR=3.29，95%CI（2.76，3.92），P<0.000 01]；在不良反应方面，联合用药不会增加其发生率[OR=0.87，95%CI（0.67，1.14），P=0.31]。亚组分析显示，联用舒巴坦制剂可降低替加环素的不良反应发生率[OR=0.51，95%CI（0.28，0.93），P=0.03]。结论 替加环素联合舒巴坦制剂治疗多重耐药/泛耐药鲍曼不动杆菌感染优于单用替加环素或单用舒巴坦制剂。

Abstract:

OBJECTIVE To evaluate the efficacy of tigecycline combined with sulbactam in the treatment of multidrug/extensively drug resistant Acinetobacter baumannii infection. METHODS Systematic search was performed of the CNKI, Wangfang Data, CBM, PubMed, The Cochrane Library, Web of science, Embase from inception to July 1, 2018. The retrieval method was subject headings combined with free words search. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. RESULTS A total of 1 062 articles were retrieved, and 46 articles met the criteria were selected. The results of meta-analysis showed that for overall efficacy and bacterial clearance, tigacycline combined with sulbactam has more advantages than tigacycline alone or sulbactam alone[OR=3.90, 95%CI(3.25, 4.68), P<0.000 01],[OR=3.29, 95%CI(2.76, 3.92), P<0.000 01]; for adverse reactions, combination therapy didn't increase the incidence[OR=0.87, 95%CI(0.67, 1.14), P=0.31]. Subgroup analysis showed that the combined with sulbactam could reduce the incidence of adverse reactions vs tigacycline alone[OR=0.51, 95%CI (0.28, 0.93), P=0.03]. CONCLUSION Tigacycline combined with sulbactam is superior to tigacycline alone or sulbactam alone in the treatment of multidrug/extensively drug resistant Acinetobacter baumannii infections.