PMID- 31577763
OWN - NLM
STAT- MEDLINE
DCOM- 20191014
LR  - 20191114
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 98
IP  - 40
DP  - 2019 Oct
TI  - Carbapenems vs tigecycline for the treatment of complicated intra-abdominal 
      infections: A Bayesian network meta-analysis of randomized clinical trials.
PG  - e17436
LID - 10.1097/MD.0000000000017436 [doi]
LID - e17436
AB  - BACKGROUND: Complicated intra-abdominal infections (cIAIs) are common in clinical 
      practice, caused by a mixture of aerobic and anaerobic bacteria, increase the 
      risk of mortality. Carbapenems and tigecycline (TGC) are recommended for 
      antimicrobial therapies for cIAIs. OBJECTIVE: To compare the effectiveness and 
      safety of different carbapenems vs TGC for the treatment of cIAIs. METHODS: 
      PubMed, Embase, Medline (via Ovid SP) and Cochrane library databases were 
      systematically searched. We included randomized controlled trials (RCTs) 
      comparing different carbapenems vs TGC for the treatment of cIAIs. The pooled 
      odds ratio (OR) with 95% credible interval (CrI) was calculated by Markov chain 
      Monte Carlo methods. We estimated summary ORs using pairwise and network 
      meta-analysis with random effects. RESULTS: Fifteen studies involving 6745 
      participants were included in the analysis. Five different carbapenems and TGC 
      were ultimately evaluated in this study. Although, the efficacy of carbapenems 
      and TGC by ORs with corresponding 95% CrIs had not yet reached statistical 
      differences, the cumulative rank probability indicated that clinical treatment 
      success from best to worst was doripenem (DOPM), meropenem (MEPM), 
      imipenem/cilastatin (IC), biapenem (BAPM), TGC and imipenem/cilastatin/relebactam 
      (ICRB); microbiological treatment success from best to worst was DOPM, MEPM, IC, 
      BAPM, ICRB and TGC. As for the risk of adverse events (AEs), TGC showed higher 
      risk of AEs compared with IC (OR = 1.53, 95% CrI = 1.02-2.41), the remain 
      antibiotic agents from lower to higher was MEPM, IC, BAPM, DOPM, ICRB and TGC. 
      The risk of mortality from lower to higher was BAPM, DOPM, MEPM, IC, TGC and 
      ICRB. CONCLUSION: No differences in clinical and microbiological outcomes were 
      observed between different carbapenems and TGC. Balancing the evidence for drug 
      efficacy and side effects, DOPM appears to be the best available treatment for 
      cIAIs. Therefore, it is reasonable to consider that DOPM is one of the best 
      carbapenem monotherapy for cIAIs. MEPM and IC was also associated with higher 
      rates of clinical and microbiological treatment success following DOPM. Empiric 
      antimicrobial treatment of patients with cIAIs should be selected in light of the 
      local bacterial epidemiology and patterns of resistance.
FAU - Chen, Lingyuan
AU  - Chen L
AD  - Department of Pharmacy.
FAU - Liang, Xueyan
AU  - Liang X
AD  - Department of Pharmacy.
FAU - Jiang, Junsong
AU  - Jiang J
AD  - Department of Reproductive Medicine, The People's Hospital of Hechi, Hechi, PR 
      China.
FAU - Li, Xianshu
AU  - Li X
AD  - Department of Pharmacy.
FAU - Li, Yan
AU  - Li Y
AD  - Department of Pharmacy.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Carbapenems)
RN  - 70JE2N95KR (Tigecycline)
SB  - IM
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Bayes Theorem
MH  - Carbapenems/*therapeutic use
MH  - Humans
MH  - Intraabdominal Infections/*drug therapy
MH  - Network Meta-Analysis
MH  - Tigecycline/*therapeutic use
PMC - PMC6783191
COIS- The authors have no conflicts of interests to disclose.
EDAT- 2019/10/03 06:00
MHDA- 2019/10/15 06:00
PMCR- 2019/10/04
CRDT- 2019/10/03 06:00
PHST- 2019/10/03 06:00 [entrez]
PHST- 2019/10/03 06:00 [pubmed]
PHST- 2019/10/15 06:00 [medline]
PHST- 2019/10/04 00:00 [pmc-release]
AID - 00005792-201910040-00069 [pii]
AID - MD-D-19-02944 [pii]
AID - 10.1097/MD.0000000000017436 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2019 Oct;98(40):e17436. doi: 10.1097/MD.0000000000017436.