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Evaluation of the efficacy and safety of ceftazidime/avibactam in the treatment of Gram-negative bacterial infections: a systematic review and meta-analysis.
Int J Antimicrob Agents. 2018 Oct; 52(4):443-450.IJ

Abstract

Data on the efficacy and safety of ceftazidime/avibactam (CAZ-AVI) are limited. A systematic review and meta-analysis was conducted to clarify the role of CAZ-AVI for patients with serious Gram-negative bacterial infections. The PubMed, EMBASE and Cochrane Library databases were searched for randomised controlled trials (RCTs) and cohort studies involving CAZ-AVI. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model. Twelve articles (4951 patients) were included, consisting of nine RCTs and three observational studies comparing CAZ-AVI with other regimens, e.g. carbapenems or colistin. CAZ-AVI showed a comparable clinical response (RR = 0.99, 95% CI 0.96-1.02; I2 = 0%) and non-inferior bacterial eradication (RR = 1.04, 95% CI 0.93-1.17; I2 = 79.1%) to carbapenems. No significant difference was detected between groups regarding mortality and adverse events. Moreover, subgroup analyses demonstrated that CAZ-AVI improved the clinical response (RR = 1.61, 95% CI 1.13-2.29) with reduced mortality (RR = 0.29, 95% CI 0.13-0.63) in patients infected by carbapenem-resistant Enterobacteriaceae versus comparators. Likewise, CAZ-AVI improved the clinical cure rate of bloodstream infections (RR = 2.11, 95% CI 1.54-2.88). An improved ability of CAZ-AVI in microbiological eradication was also detected in patients with complicated urinary tract infections (RR = 1.13, 95% CI 1.05-1.21). CAZ-AVI exhibited comparable efficacy and safety with carbapenems. Therefore, this agent might be a potential powerful agent for patients with serious Gram-negative bacterial infections.

Authors+Show Affiliations

Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China.Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China. Electronic address: gaoyuan@renji.com.Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai 200127, China. Electronic address: cuimin@renji.com.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

30012440

Citation

Zhong, Han, et al. "Evaluation of the Efficacy and Safety of Ceftazidime/avibactam in the Treatment of Gram-negative Bacterial Infections: a Systematic Review and Meta-analysis." International Journal of Antimicrobial Agents, vol. 52, no. 4, 2018, pp. 443-450.
Zhong H, Zhao XY, Zhang ZL, et al. Evaluation of the efficacy and safety of ceftazidime/avibactam in the treatment of Gram-negative bacterial infections: a systematic review and meta-analysis. Int J Antimicrob Agents. 2018;52(4):443-450.
Zhong, H., Zhao, X. Y., Zhang, Z. L., Gu, Z. C., Zhang, C., Gao, Y., & Cui, M. (2018). Evaluation of the efficacy and safety of ceftazidime/avibactam in the treatment of Gram-negative bacterial infections: a systematic review and meta-analysis. International Journal of Antimicrobial Agents, 52(4), 443-450. https://doi.org/10.1016/j.ijantimicag.2018.07.004
Zhong H, et al. Evaluation of the Efficacy and Safety of Ceftazidime/avibactam in the Treatment of Gram-negative Bacterial Infections: a Systematic Review and Meta-analysis. Int J Antimicrob Agents. 2018;52(4):443-450. PubMed PMID: 30012440.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of the efficacy and safety of ceftazidime/avibactam in the treatment of Gram-negative bacterial infections: a systematic review and meta-analysis. AU - Zhong,Han, AU - Zhao,Xian-Yuan, AU - Zhang,Zai-Li, AU - Gu,Zhi-Chun, AU - Zhang,Chi, AU - Gao,Yuan, AU - Cui,Min, Y1 - 2018/08/31/ PY - 2018/02/21/received PY - 2018/07/04/revised PY - 2018/07/07/accepted PY - 2018/7/18/pubmed PY - 2019/4/9/medline PY - 2018/7/18/entrez KW - Avibactam KW - Carbapenem-resistant Enterobacteriaceae KW - Clinical response KW - Gram-negative bacteria KW - Microbiological response KW - Safety SP - 443 EP - 450 JF - International journal of antimicrobial agents JO - Int. J. Antimicrob. Agents VL - 52 IS - 4 N2 - Data on the efficacy and safety of ceftazidime/avibactam (CAZ-AVI) are limited. A systematic review and meta-analysis was conducted to clarify the role of CAZ-AVI for patients with serious Gram-negative bacterial infections. The PubMed, EMBASE and Cochrane Library databases were searched for randomised controlled trials (RCTs) and cohort studies involving CAZ-AVI. Summary risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model. Twelve articles (4951 patients) were included, consisting of nine RCTs and three observational studies comparing CAZ-AVI with other regimens, e.g. carbapenems or colistin. CAZ-AVI showed a comparable clinical response (RR = 0.99, 95% CI 0.96-1.02; I2 = 0%) and non-inferior bacterial eradication (RR = 1.04, 95% CI 0.93-1.17; I2 = 79.1%) to carbapenems. No significant difference was detected between groups regarding mortality and adverse events. Moreover, subgroup analyses demonstrated that CAZ-AVI improved the clinical response (RR = 1.61, 95% CI 1.13-2.29) with reduced mortality (RR = 0.29, 95% CI 0.13-0.63) in patients infected by carbapenem-resistant Enterobacteriaceae versus comparators. Likewise, CAZ-AVI improved the clinical cure rate of bloodstream infections (RR = 2.11, 95% CI 1.54-2.88). An improved ability of CAZ-AVI in microbiological eradication was also detected in patients with complicated urinary tract infections (RR = 1.13, 95% CI 1.05-1.21). CAZ-AVI exhibited comparable efficacy and safety with carbapenems. Therefore, this agent might be a potential powerful agent for patients with serious Gram-negative bacterial infections. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/30012440/Evaluation_of_the_efficacy_and_safety_of_ceftazidime/avibactam_in_the_treatment_of_Gram_negative_bacterial_infections:_a_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -