PMID- 31914101
OWN - NLM
STAT- MEDLINE
DCOM- 20200129
LR  - 20221005
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 99
IP  - 2
DP  - 2020 Jan
TI  - Carbapenems vs alternative antibiotics for the treatment of complicated urinary 
      tract infection: A systematic review and network meta-analysis.
PG  - e18769
LID - 10.1097/MD.0000000000018769 [doi]
LID - e18769
AB  - BACKGROUND: Complicated urinary tract infections (cUTI) are universal reasons for 
      hospitalization, and highly likely to develop into sepsis or septic shock. 
      Carbapenem antibiotics with potentially higher efficacy or with fewer and milder 
      side effects have increased in popularity, but evidence is limited by a scarcity 
      of randomized controlled trials (RCTs) comparing different carbapenem antibiotics 
      for cUTI. Network meta-analysis is a useful tool to compare multiple treatments 
      when there is limited or no direct evidence available. OBJECTIVE: The aim of this 
      study is to compare the efficacy and safety of different carbapenems with 
      alternative antibiotics for the treatment of cUTI. METHODS: Pubmed, Medline, 
      CENTRAL, and Embase were searched in November 2018. Studies of cUTI patients 
      receiving carbapenem were included. We performed network meta-analysis to 
      estimate the risk ratio (RR) and 95% credible interval (CrI) from both direct and 
      indirect evidence; traditional meta-analysis was also performed. Primary outcomes 
      were clinical and microbiological treatment success. RESULTS: A total of 19 
      studies and 7380 patients were included in the analysis. Doripenem (DOPM) was 
      associated with lower clinical treatment success rates than other carbapenems. 
      Although the efficacy of other carbapenems by RRs with 95% CrIs did not show 
      statistical differences, the cumulative rank probability indicated that 
      meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) had higher 
      clinical and microbiological treatment success rates; imipenem/cilastatin (IC) 
      and MV showed higher risk of adverse events (AEs). CONCLUSIONS: MV was associated 
      with higher treatment success rates for cUTI, especially for cUTI caused by 
      carbapenem-resistant uropathogens, but also with higher risk of AEs. Our findings 
      suggest MV as a first-choice treatment of carbapenem-resistant cUTI. ETPM, BAPM, 
      and meropenem (MEPM) is another reasonable choice for cUTI empiric therapy.
FAU - Tan, Xinmei
AU  - Tan X
AD  - Department of Anesthesiology.
FAU - Pan, Qiwen
AU  - Pan Q
AD  - Department of Gynecology.
FAU - Mo, Changgan
AU  - Mo C
AD  - Department of Cardiovascular medicine.
FAU - Li, Xianshu
AU  - Li X
AD  - Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China.
FAU - Liang, Xueyan
AU  - Liang X
AD  - Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China.
FAU - Li, Yan
AU  - Li Y
AD  - Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China.
FAU - Lan, Yingnian
AU  - Lan Y
AD  - Department of Anesthesiology.
FAU - Chen, Lingyuan
AU  - Chen L
AD  - Department of Pharmacy, The People's Hospital of Hechi, Hechi, Guangxi, China.
LA  - eng
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)
SB  - IM
MH  - Anti-Bacterial Agents/adverse effects/*therapeutic use
MH  - Carbapenems/adverse effects/*therapeutic use
MH  - Humans
MH  - Network Meta-Analysis
MH  - Urinary Tract Infections/*drug therapy/microbiology
PMC - PMC6959894
COIS- The authors report no conflicts of interest.
EDAT- 2020/01/09 06:00
MHDA- 2020/01/30 06:00
PMCR- 2020/01/10
CRDT- 2020/01/09 06:00
PHST- 2020/01/09 06:00 [entrez]
PHST- 2020/01/09 06:00 [pubmed]
PHST- 2020/01/30 06:00 [medline]
PHST- 2020/01/10 00:00 [pmc-release]
AID - 00005792-202001100-00092 [pii]
AID - MD-D-19-04958 [pii]
AID - 10.1097/MD.0000000000018769 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2020 Jan;99(2):e18769. doi: 10.1097/MD.0000000000018769.