Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia.
The comparative effectiveness and safety of carbapenems with other beta-lactams and fluoroquinolones for the empirical treatment of patients with hospital-acquired pneumonia remains controversial. In the present study, a meta-analysis of 12 relevant randomised controlled trials was performed. Overall, carbapenems were associated with lower mortality than fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides (odds ratio 0.72, 95% confidence interval 0.55-0.95). There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91-1.29), microbiological success (1.04, 0.72-1.50) or development of adverse effects (0.81, 0.46-1.43). In the subset of patients with Pseudomonas aeruginosa pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22-0.82) and lower eradication of P. strains (0.50, 0.24-0.89). Carbapenems are equivalent to fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospital-acquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. In patients with Pseudomonas aeruginosa pneumonia, carbapenems are associated with worse outcomes than the comparators.
Siempos
I I
II
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Vardakas
K Z
KZ
Manta
K G
KG
Falagas
M E
ME
D000151:Acinetobacter Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D040981:Acinetobacter baumannii; D000328:Adult; D000617:Aminoglycosides / Q000009:adverse effects / Q000627:therapeutic use; D015780:Carbapenems / Q000009:adverse effects / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D007362:Intensive Care Units; D000077731:Meropenem; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D015996:Survival Rate; D013845:Thienamycins / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome; D047090:beta-Lactams / Q000009:adverse effects / Q000627:therapeutic use
D000617:Aminoglycosides; D015780:Carbapenems; D024841:Fluoroquinolones; D013845:Thienamycins; D047090:beta-Lactams; D000077731:Meropenem