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Clinical cure rate and cost-effectiveness of carbapenem-sparing beta-lactams vs. meropenem for Gram-negative infections: A systematic review, meta-analysis, and cost-effectiveness analysis.
Int J Antimicrob Agents. 2019 Dec; 54(6):790-797.IJ

Abstract

The increasing incidence of infections caused by extended-spectrum beta-lactamase (ESBL)/AmpC-producing bacteria leads to increasing use of carbapenems and risk of carbapenem resistance. Treatment success of carbapenem-sparing beta-lactams (CSBs) for ESBL infections is unclear. The aim of this study was to appraise the clinical cure rate and estimate the cost-effectiveness of meropenem vs. CSBs (piperacillin-tazobactam, temocillin, ceftazidime-avibactam, and ceftolozane-tazobactam) for urinary tract infections (UTIs) or intra-abdominal infections (IAIs) due to ESBL/AmpC-producing bacteria. A systematic literature search of the Cochrane library, EMBASE, PubMed, and Web of Science was conducted to identify studies assessing the clinical cure rate of the antibiotics. To assess the cost-effectiveness of CSBs vs. meropenem, a combined decision analytic and Markov model was probabilistically analysed over a 5-year period. The main outcome was presented as the incremental cost-effectiveness ratio and evaluated with a threshold of €20 000 per life year gained (LYG). From 656 identified articles, 17 and 14 studies were included in the qualitative synthesis and quantitative synthesis, respectively. A clinical cure of ceftazidime-avibactam and ceftolozane-tazobactam was comparable to meropenem in patients with complicated IAIs (cIAIs) due to ESBL (Risk ratio [RR]=1·04, 95% confidence interval [CI]=0·95-1·13). Both temocillin and ceftolozane-tazobactam were deemed cost-effective compared to meropenem with €157·58 and €13 398·34 per LYG, respectively, in patients with UTIs due to ESBL. However, only ceftazidime-avibactam (plus metronidazole) was cost-effective for the treatment of IAIs, with €16 916·77 per LYG. These results show that several CSBs can be considered as viable candidates for the treatment of UTIs and IAIs caused by ESBL.

Authors+Show Affiliations

Department of Medical Microbiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands; Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, 13 Le Thanh Tong, Hanoi, Vietnam. Electronic address: chinguyen@hup.edu.vn.Department of Medical Microbiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands.Department of Pharmacy, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands.Department of Internal Medicine, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands.Department of Medical Microbiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands.Department of Health Evidence, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands.Department of Medical Microbiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands. Electronic address: heiman.wertheim@radboudumc.nl.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31284041

Citation

Nguyen, Chi Phuong, et al. "Clinical Cure Rate and Cost-effectiveness of Carbapenem-sparing Beta-lactams Vs. Meropenem for Gram-negative Infections: a Systematic Review, Meta-analysis, and Cost-effectiveness Analysis." International Journal of Antimicrobial Agents, vol. 54, no. 6, 2019, pp. 790-797.
Nguyen CP, Dan Do TN, Bruggemann R, et al. Clinical cure rate and cost-effectiveness of carbapenem-sparing beta-lactams vs. meropenem for Gram-negative infections: A systematic review, meta-analysis, and cost-effectiveness analysis. Int J Antimicrob Agents. 2019;54(6):790-797.
Nguyen, C. P., Dan Do, T. N., Bruggemann, R., Ten Oever, J., Kolwijck, E., Adang, E. M. M., & Wertheim, H. F. L. (2019). Clinical cure rate and cost-effectiveness of carbapenem-sparing beta-lactams vs. meropenem for Gram-negative infections: A systematic review, meta-analysis, and cost-effectiveness analysis. International Journal of Antimicrobial Agents, 54(6), 790-797. https://doi.org/10.1016/j.ijantimicag.2019.07.003
Nguyen CP, et al. Clinical Cure Rate and Cost-effectiveness of Carbapenem-sparing Beta-lactams Vs. Meropenem for Gram-negative Infections: a Systematic Review, Meta-analysis, and Cost-effectiveness Analysis. Int J Antimicrob Agents. 2019;54(6):790-797. PubMed PMID: 31284041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical cure rate and cost-effectiveness of carbapenem-sparing beta-lactams vs. meropenem for Gram-negative infections: A systematic review, meta-analysis, and cost-effectiveness analysis. AU - Nguyen,Chi Phuong, AU - Dan Do,Thuc Nguyen, AU - Bruggemann,Roger, AU - Ten Oever,Jaap, AU - Kolwijck,Eva, AU - Adang,Eddy M M, AU - Wertheim,Heiman F L, Y1 - 2019/07/05/ PY - 2019/03/15/received PY - 2019/07/03/accepted PY - 2019/7/10/pubmed PY - 2020/4/17/medline PY - 2019/7/9/entrez KW - Carbapenem-sparing beta-lactams KW - Extended-spectrum beta-lactamase KW - Intra-abdominal infection KW - Meropenem KW - Urinary tract infection SP - 790 EP - 797 JF - International journal of antimicrobial agents JO - Int J Antimicrob Agents VL - 54 IS - 6 N2 - The increasing incidence of infections caused by extended-spectrum beta-lactamase (ESBL)/AmpC-producing bacteria leads to increasing use of carbapenems and risk of carbapenem resistance. Treatment success of carbapenem-sparing beta-lactams (CSBs) for ESBL infections is unclear. The aim of this study was to appraise the clinical cure rate and estimate the cost-effectiveness of meropenem vs. CSBs (piperacillin-tazobactam, temocillin, ceftazidime-avibactam, and ceftolozane-tazobactam) for urinary tract infections (UTIs) or intra-abdominal infections (IAIs) due to ESBL/AmpC-producing bacteria. A systematic literature search of the Cochrane library, EMBASE, PubMed, and Web of Science was conducted to identify studies assessing the clinical cure rate of the antibiotics. To assess the cost-effectiveness of CSBs vs. meropenem, a combined decision analytic and Markov model was probabilistically analysed over a 5-year period. The main outcome was presented as the incremental cost-effectiveness ratio and evaluated with a threshold of €20 000 per life year gained (LYG). From 656 identified articles, 17 and 14 studies were included in the qualitative synthesis and quantitative synthesis, respectively. A clinical cure of ceftazidime-avibactam and ceftolozane-tazobactam was comparable to meropenem in patients with complicated IAIs (cIAIs) due to ESBL (Risk ratio [RR]=1·04, 95% confidence interval [CI]=0·95-1·13). Both temocillin and ceftolozane-tazobactam were deemed cost-effective compared to meropenem with €157·58 and €13 398·34 per LYG, respectively, in patients with UTIs due to ESBL. However, only ceftazidime-avibactam (plus metronidazole) was cost-effective for the treatment of IAIs, with €16 916·77 per LYG. These results show that several CSBs can be considered as viable candidates for the treatment of UTIs and IAIs caused by ESBL. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/31284041/Clinical_cure_rate_and_cost_effectiveness_of_carbapenem_sparing_beta_lactams_vs__meropenem_for_Gram_negative_infections:_A_systematic_review_meta_analysis_and_cost_effectiveness_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(19)30183-9 DB - PRIME DP - Unbound Medicine ER -