PMID- 34918626
OWN - NLM
STAT- MEDLINE
DCOM- 20220120
LR  - 20230103
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 100
IP  - 50
DP  - 2021 Dec 17
TI  - Comparative efficacy and safety of antipseudomonal beta-lactams for pediatric 
      febrile neutropenia: A systematic review and Bayesian network meta-analysis.
PG  - e27266
LID - 10.1097/MD.0000000000027266 [doi]
LID - e27266
AB  - BACKGROUND: Antipseudomonal beta-lactams have been used for the treatment of febrile 
      neutropenia (FN); however, the efficacy and safety of antipseudomonal beta-lactams 
      in pediatric patients remain unclear. The aim of this study was to 
      comprehensively compare the efficacy and side effects of optional antipseudomonal 
      beta-lactams for pediatric FN. METHODS: PubMed, Embase, Medline, and Cochrane 
      Library were systematically searched from their inception to December 18, 2020. 
      Eligible randomized controlled trials in which pediatric FN patients were treated 
      with an empiric monotherapy of antipseudomonal beta-lactams were selected. Data 
      synthesis was performed using WinBUGS 14.0 software and meta packages implemented 
      in R 3.6.2. Random-effects network meta-analysis was performed, and dichotomous 
      data were pooled as odds ratios with 95% confidence intervals. The primary 
      outcome was treatment success without modification; the secondary outcomes were 
      adverse events (AEs), all-cause mortality, and new infections. The GRADE tool was 
      used to assess the quality of the evidence. The protocol was registered with 
      PROSPERO ID CRD42021226763. RESULTS: Eighteen studies with 2517 patients were 
      included. The results showed no statistically significant difference between the 
      optional antipseudomonal beta-lactams in the outcomes of treatment success without 
      modification, all AEs, all-cause mortality, and new infections for pediatric FN. 
      Based on the results of Bayesian rank probability, meropenem was ranked highest 
      among all the treatment options with regard to treatment success without 
      modification benefit; ceftazidime and meropenem were associated with a lower risk 
      of AEs; cefoperazone/sulbactam and piperacillin/tazobactam were associated with a 
      lower risk of mortality, and piperacillin/tazobactam and meropenem were 
      associated with a lower risk of new infections. The quality of evidence was 
      moderate. CONCLUSIONS: Meropenem and piperacillin/tazobactam were found to be 
      better with regard to treatment success without modification, with a comparable 
      safety profile. Therefore, our findings support the use of meropenem and 
      piperacillin/tazobactam as a treatment option for pediatric FN patients.
CI  - Copyright (c) 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Tan, Xinmei
AU  - Tan X
AD  - Department of anesthesiology, The People's Hospital of Hechi, Hechi, Guangxi, 
      China.
FAU - Li, Yan
AU  - Li Y
AD  - Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, People's Republic of China.
FAU - Xi, Jiaxi
AU  - Xi J
AD  - Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, People's Republic of China.
FAU - Guo, Sitong
AU  - Guo S
AD  - Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, People's Republic of China.
FAU - Su, Henghai
AU  - Su H
AD  - Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, People's Republic of China.
FAU - Chen, Xiaoyu
AU  - Chen X
AD  - Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, People's Republic of China.
FAU - Liang, Xueyan
AU  - Liang X
AUID- ORCID: 0000-0002-4043-6066
AD  - Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous 
      Region, Nanning, Guangxi, People's Republic of China.
LA  - eng
GR  - 2018GXNSFAA281159/Natural Science Foundation of Guangxi Province/
PT  - Journal Article
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (beta-Lactams)
RN  - 157044-21-8 (Piperacillin, Tazobactam Drug Combination)
RN  - 71OTZ9ZE0A (Imipenem)
RN  - 9M416Z9QNR (Ceftazidime)
RN  - FV9J3JU8B1 (Meropenem)
SB  - IM
MH  - Anti-Bacterial Agents/adverse effects/*therapeutic use
MH  - Ceftazidime/therapeutic use
MH  - Child
MH  - Drug Therapy, Combination
MH  - Febrile Neutropenia/*drug therapy
MH  - Female
MH  - Humans
MH  - Imipenem/therapeutic use
MH  - Male
MH  - Meropenem/therapeutic use
MH  - Network Meta-Analysis
MH  - Piperacillin, Tazobactam Drug Combination/therapeutic use
MH  - Pseudomonas Infections/*drug therapy
MH  - Pseudomonas aeruginosa
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
MH  - beta-Lactams/adverse effects/*therapeutic use
PMC - PMC8678002
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2021/12/18 06:00
MHDA- 2022/01/21 06:00
PMCR- 2021/12/17
CRDT- 2021/12/17 08:42
PHST- 2021/05/04 00:00 [received]
PHST- 2021/08/31 00:00 [accepted]
PHST- 2021/12/17 08:42 [entrez]
PHST- 2021/12/18 06:00 [pubmed]
PHST- 2022/01/21 06:00 [medline]
PHST- 2021/12/17 00:00 [pmc-release]
AID - 00005792-202112170-00001 [pii]
AID - MD-D-21-03412 [pii]
AID - 10.1097/MD.0000000000027266 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2021 Dec 17;100(50):e27266. doi: 
      10.1097/MD.0000000000027266.