PMID- 32384444
OWN - NLM
STAT- MEDLINE
DCOM- 20200520
LR  - 20200616
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 99
IP  - 19
DP  - 2020 May
TI  - Novel beta-Lactam/beta-Lactamase inhibitor combinations vs alternative antibiotics in 
      the treatment of complicated urinary tract infections: A meta-analysis of 
      randomized controlled trials.
PG  - e19960
LID - 10.1097/MD.0000000000019960 [doi]
LID - e19960
AB  - OBJECTIVES: This meta-analysis assessed the efficacy and safety of novel 
      beta-lactam/beta-lactamase inhibitor combinations in the treatment of complicated 
      urinary tract infection (cUTI)/acute pyelonephritis (APN). METHODS: PubMed, Web 
      of Science, EBSCO (Elton B. Stephens Co.), Cochrane Library, Ovid MEDLINE, and 
      Embase databases were accessed until November 21, 2019. In this meta-analysis, 
      only randomized controlled trials comparing the treatment efficacy of novel 
      beta-lactam/beta-lactamase inhibitor combinations with other antibiotics for cUTI/APN 
      in adult patients were included. The outcomes included the clinical and 
      microbiological responses, and risk of adverse events (AEs). RESULTS: Overall, 
      the experimental group treated with a novel beta-lactam/beta-lactamase inhibitor 
      combination and the control group comprised 1346 and 1376 patients, respectively. 
      No significant difference in the clinical response rate at test-of-cure was 
      observed between the novel beta-lactam/beta-lactamase inhibitor combination and 
      comparators among the microbiological modified intent-to-treat population (89.1% 
      vs 88.3%, OR, 1.04; 95% confidence interval [CI], 0.76-1.42; I = 28%) and the 
      microbiologically evaluable population (95.2% vs 94.7%, OR, 1.12; 95% CI, 
      0.68-1.84; I = 0%). Additionally, the novel beta-lactam/beta-lactamase inhibitor 
      combination was associated with a better microbiological response at test-of-cure 
      than the comparators among the microbiological modified intent-to-treat 
      population (74.4% vs 68.5%, OR, 1.34; 95% CI, 1.04-1.72; I = 45%) and 
      microbiologically evaluable population (80.1% vs 72.5%, OR, 1.49; 95% CI, 
      1.06-2.10; I = 58%). Finally, the risk of AEs associated with the novel 
      beta-lactam/beta-lactamase inhibitor combination was similar to that associated with 
      the comparators (treatment-emergent adverse events [TEAE], OR, 1.04; 95% CI, 
      0.87-1.23; I = 19%; serious AEs, OR, 1.21; 95% CI, 0.82-1.76; I = 0%; treatment 
      discontinuation for drug-related TEAE, OR, 077; 95% CI, 0.38-1.56, I = 5%). The 
      all-cause mortality did not differ between the novel beta-lactam/beta-lactamase 
      inhibitor combination and comparators (OR, 1.19; 95% CI, 0.37-3.81; I = 0%). 
      CONCLUSIONS: The clinical and microbiological responses of novel 
      beta-lactam/beta-lactamase inhibitor combinations in the treatment of cUTI/APN are 
      similar to those of other available antibiotics. These combinations also share a 
      safety profile similar to that of other antibiotics.
FAU - Lu, Li-Chin
AU  - Lu LC
AD  - School of Management, Putian University, Putian, China.
FAU - Lai, Chih-Cheng
AU  - Lai CC
AD  - Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan 
      Branch.
FAU - Chang, Shen-Peng
AU  - Chang SP
AD  - Yijia Pharmacy, Tainan, Taiwan.
FAU - Lan, Shao-Huan
AU  - Lan SH
AD  - School of Pharmaceutical Sciences and Medical Technology, Putian University, 
      Putian, China.
FAU - Hung, Shun-Hsing
AU  - Hung SH
AD  - Division of Urology, Department of Surgery, Chi-Mei Hospital, Chia Li.
FAU - Lin, Wei-Ting
AU  - Lin WT
AD  - Department of Orthopedic, Chi Mei Medical Center, Tainan, Taiwan.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (beta-Lactamase Inhibitors)
RN  - 0 (beta-Lactams)
SB  - IM
MH  - Anti-Bacterial Agents/pharmacology
MH  - Drug Therapy, Combination/methods
MH  - Humans
MH  - *Pyelonephritis/drug therapy/microbiology
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - *Urinary Tract Infections/drug therapy/microbiology
MH  - beta-Lactamase Inhibitors/*pharmacology
MH  - beta-Lactams/*antagonists & inhibitors
PMC - PMC7220034
COIS- The authors have no funding and conflicts of interests to disclose.
EDAT- 2020/05/10 06:00
MHDA- 2020/05/21 06:00
PMCR- 2020/05/08
CRDT- 2020/05/09 06:00
PHST- 2020/05/09 06:00 [entrez]
PHST- 2020/05/10 06:00 [pubmed]
PHST- 2020/05/21 06:00 [medline]
PHST- 2020/05/08 00:00 [pmc-release]
AID - 00005792-202005080-00021 [pii]
AID - MD-D-20-00631 [pii]
AID - 10.1097/MD.0000000000019960 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2020 May;99(19):e19960. doi: 10.1097/MD.0000000000019960.