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Carbapenems versus alternative β-lactams for the treatment of nosocomial pneumonia: A systematic review and meta-analysis.
Int J Antimicrob Agents. 2018 Apr 14;:
Authors: Nicholas O'Donnell J, Rhodes NJ, Lopez J, Jett R, Scheetz MH
Abstract
BACKGROUND: Carbapenems have demonstrated efficacy in treating nosocomial pneumonias in clinical trials despite a reported low lung penetration compared to other β-lactams. Preserving the clinical activity of carbapenems through stewardship efforts is essential. This review aims to identify if differences in outcomes exist, potentially as a function of decreased penetration.
METHODS: PubMed and Cochrane Library were systematically searched for clinical trials comparing carbapenems to other anti-pseudomonal β-lactams for the treatment of nosocomial pneumonia through December 2016. Trials reporting clinical and microbiologic outcomes associated with treatment were included. Pediatric studies and those with uneven comparators (e.g., carbapenem vs. combination Gram-negative therapy) were excluded. Fixed effects models were used to evaluate the impact of treatment on the odds of clinical failure, death, or microbiologic failure.
RESULTS: 169 unique articles were identified; five met inclusion criteria and comprised 640 patients in the carbapenem and 634 in the β-lactam groups. No differences in clinical failure (odds ratio [OR] 1.08; 95% confidence interval [CI] [0.81-1.44];I2=16%) or mortality (OR 0.75; CI 0.57-1.11;I2=0%) were noted between groups. Patients infected with P. aeruginosa and treated with imipenem were more likely to experience clinical failure (OR 4.21; CI 1.51-11.12;I2=44%) and to develop resistance to the study carbapenem (OR 2.86; CI 1.08-6.44;I2= 13%) than those treated with alternative β-lactams.
CONCLUSIONS: No differences in clinical outcomes were observed between carbapenems and non-carbapenem β-lactams in nosocomial pneumonias. Those infected with P. aeruginosa fared worse and were more likely to have resistance develop if they were treated with imipenem. Additional studies are warranted.
PMID: 29665442 [PubMed - as supplied by publisher]