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Int J Antimicrob Agents. 2019 Sep 15. pii: S0924-8579(19)30250-X. doi: 10.1016/j.ijantimicag.2019.09.007. [Epub ahead of print]

Ceftazidime-avibactam versus carbapenems for the treatment of infections caused by Enterobacteriaceae: a meta-analysis of randomized controlled trials.

Author information

1
Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, 28 Fu Xing Road, Beijing 100853, People's Republic of China.
2
Center of Medicine Clinical Research, Department of Pharmacy, PLA General Hospital, 28 Fu Xing Road, Beijing 100853, People's Republic of China. Electronic address: caicai_hh@126.com.

Abstract

BACKGROUND:

Enterobacteriaceae are the most common pathogens in nosocomial and community infections. Carbapenems are widely used as the most effective antibacterial agents against Enterobacteriaceae. However, the increasing use of carbapenems has accelerated the emergence of carbapenem-resistant Enterobacteriaceae (CRE).

OBJECTIVES:

We aimed to systematically review recently published data in order to compare the clinical efficacy and safety of ceftazidime-avibactam (CAZ-AVI) and carbapenems in the treatment of Enterobacteriaceae infections. Moreover, we also attempted to assess whether it was feasible to treat Enterobacteriaceae infections with CAZ-AVI instead of carbapenems.

METHODS:

A comprehensive search of the randomized controlled trials (RCTs) was performed using databases of Medline, Embase and Cochrane Library, which compared the efficacy and safety of CAZ-AVI and carbapenems for the treatment of Enterobacteriaceae infections. Clinical success, microbiological success, adverse events (AEs), serious adverse events (SAEs) and mortality were assessed as the main outcomes. The meta-analysis was conducted using Review Manager Software version 5.3.

RESULTS:

Three RCTs consisting of 1,186 patients were included in the present meta-analysis. The meta-analysis showed that there were no significant differences between CAZ-AVI and carbapenems in clinical success (RD=0.00, 95%CI= [-0.06, 0.06], P=0.99) and microbiological success (RD = 0.07, 95%CI= [-0.04, 0.18], P=0.21), as well as in AEs (RD=0.00, 95%CI= [-0.02, 0.03], P=0.81). SAEs of the CAZ-AVI were numerically higher than carbapenems (RD=0.02, 95%CI= [-0.00, 0.04], P=0.06).

CONCLUSIONS:

CAZ-AVI are comparable with carbapenems in efficacy and safety for the treatment of Enterobacteriaceae infections. More high-quality and large-scale RCTs were needed to further confirm the safety of CAZ-AVI.

TRIAL REGISTRATION:

PROSPERO ID: CRD42019116685.

KEYWORDS:

Carbapenems; Ceftazidime-avibactam; Enterobacteriaceae; Meta-analysis; β-lactam/β-lactamase inhibitor

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