PMID- 37100354
OWN - NLM
STAT- MEDLINE
DCOM- 20230619
LR  - 20230619
IS  - 1872-7913 (Electronic)
IS  - 0924-8579 (Linking)
VI  - 62
IP  - 1
DP  - 2023 Jul
TI  - Clinical efficacy and safety of novel antibiotics for complicated urinary tract 
      infection: A systematic review and meta-analysis of randomized controlled trials.
PG  - 106830
LID - S0924-8579(23)00109-7 [pii]
LID - 10.1016/j.ijantimicag.2023.106830 [doi]
AB  - OBJECTIVE: To assess the clinical efficacy and safety of novel antibiotics for 
      complicated urinary tract infections (cUTIs). METHODS: Three electronic databases 
      (Medline, Embase and the Cochrane Library) were searched from inception until 20 
      October 2022 to identify randomized controlled trials (RCTs) investigating the 
      efficacy and safety of novel antibiotics (novel beta-lactam/beta-lactamase inhibitor 
      combinations, aminoglycosides, fluoroquinolones and cefiderocol) against cUTIs. 
      The primary outcome was the clinical cure rate (CCR) at test of cure (TOC), while 
      secondary outcomes included CCR at end of treatment (EOT), microbiological 
      eradication rate, and the risk of adverse events (AEs). Trial sequential analysis 
      (TSA) was used to examine the evidence. RESULTS: In total, 11 RCTs demonstrated a 
      higher CCR [83.6% vs 80.3%, odds ratio (OR) 1.37, 95% confidence interval (CI) 
      1.08-1.74, P=0.01, I(2)=35%, 11 RCTs, 3514 participants] and microbiological 
      eradication rate (77.7% vs 67.2%, OR 1.79, 95% CI 1.46-2.20, P<0.00001, 11 RCTs, 
      4347 participants) at TOC in the intervention group compared with the control 
      group. At EOT, there was no significant difference in CCR (OR 0.96, P=0.81, 
      I(2)=4%, nine RCTs, 3429 participants) or risk of treatment-emergent AEs (OR 
      0.95, P=0.57, I(2)=51%, 11 RCTs, 5790 participants) between the intervention and 
      control groups. TSA showed robust evidence regarding microbiological eradication 
      rate and treatment-emergent AEs, while the CCR at TOC and EOT remained 
      inconclusive. CONCLUSIONS: While showing similar safety, the investigated novel 
      antibiotics may be more effective than the conventional antibiotics for patients 
      with cUTIs. However, as the pooled evidence relating to CCR remained 
      inconclusive, further studies are required to address this issue.
CI  - Copyright (c) 2023. Published by Elsevier Ltd.
FAU - Hung, Kuo-Chuan
AU  - Hung KC
AD  - School of Medicine, College of Medicine, National Sun Yat-sen University, 
      Kaohsiung, Taiwan; Department of Anaesthesiology, Chi Mei Medical Centre, Tainan 
      City, Taiwan.
FAU - Tsai, Wen-Wen
AU  - Tsai WW
AD  - Department of Education, Chi Mei Medical Centre, Tainan City, Taiwan.
FAU - Hsu, Chin-Wei
AU  - Hsu CW
AD  - Department of Pharmacy, Chi Mei Medical Centre, Tainan, Taiwan; School of 
      Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
FAU - Lai, Chih-Cheng
AU  - Lai CC
AD  - School of Medicine, College of Medicine, National Sun Yat-sen University, 
      Kaohsiung, Taiwan; Division of Hospital Medicine, Department of Internal 
      Medicine, Chi Mei Medical Centre, Tainan, Taiwan.
FAU - Tang, Hung-Jen
AU  - Tang HJ
AD  - Department of Internal Medicine, Chi Mei Medical Centre, Tainan, Taiwan.
FAU - Chen, I-Wen
AU  - Chen IW
AD  - Department of Anaesthesiology, Chi Mei Medical Centre, Liouying, Tainan City, 
      Taiwan. Electronic address: mavising@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20230424
PL  - Netherlands
TA  - Int J Antimicrob Agents
JT  - International journal of antimicrobial agents
JID - 9111860
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (beta-Lactamase Inhibitors)
SB  - IM
MH  - Humans
MH  - *Anti-Bacterial Agents/adverse effects
MH  - Randomized Controlled Trials as Topic
MH  - *Urinary Tract Infections/drug therapy/microbiology
MH  - beta-Lactamase Inhibitors/therapeutic use
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Cefepime/enmetazobactam
OT  - Cefiderocol
OT  - Ceftazidime/avibactam
OT  - Ceftolozane/tazobactam
OT  - Complicated urinary tract infection
OT  - Finafloxacin
OT  - Imipenem/cilastatin plus relebactam
OT  - Meropenem/vaborbactam
OT  - Plazomicin
EDAT- 2023/04/27 00:42
MHDA- 2023/06/19 13:08
CRDT- 2023/04/26 19:29
PHST- 2022/11/07 00:00 [received]
PHST- 2023/04/16 00:00 [revised]
PHST- 2023/04/20 00:00 [accepted]
PHST- 2023/06/19 13:08 [medline]
PHST- 2023/04/27 00:42 [pubmed]
PHST- 2023/04/26 19:29 [entrez]
AID - S0924-8579(23)00109-7 [pii]
AID - 10.1016/j.ijantimicag.2023.106830 [doi]
PST - ppublish
SO  - Int J Antimicrob Agents. 2023 Jul;62(1):106830. doi: 
      10.1016/j.ijantimicag.2023.106830. Epub 2023 Apr 24.