目的 本文通过系统回顾及meta分析的方法 ,探讨哌拉西林/他唑巴坦对比其他类抗菌药物在治疗产超广谱 β-内酰胺酶肠杆菌科细菌血流感染的疗效差异,为临床实践提供参考意见.方法检索PubMed、Cochrane library、Web of Science、中国知网 、维普数据库 、万方数据库6大中英文数据库,筛选相关文献,获得各类药物单药治疗的治疗数据及病死率数据,采用Revman 5.3软件对其进行系统分析,并进行异质性检验.结果 本研究最终纳入11篇文献,获得1620例样本.以大肠埃希菌及肺炎克雷伯杆菌为主要病原体,含少量阴沟肠杆菌等(共计31例)数据.在经验治疗的统计数据中,哌拉西林/他唑巴坦单药治疗组与碳青霉烯类单药治疗组的病死率差异无统计学意义(RR=0.86;95％CI:0.62～1.20,P>0.05);在目标治疗组中,哌拉西林/他唑巴坦单药治疗组与碳青霉烯类单药治疗组的病死率差异亦无统计学意义(RR=0.63;95％CI:0.20～1.97,P>0.05);碳青霉烯类是所占比重最大的治疗用药.结论 哌拉西林/他唑巴坦并未发现与增加产超广谱 β-内酰胺酶肠杆菌科细菌血流感染病死率相关,可以考虑作为治疗上述感染的备选药物.%Objective To study the difference between piperacillin-tazobactam and other anti-infective agents in the treatment of blood stream infection caused by extended spectrum beta-lactamase (ESBL )-producing Enterobacteriaceae by systematic review and meta-analysis . Methods PubMed , Cochrane library ,Web of Science , CNKI , Weipu DATA , and CPVIP were systematically searched . Literatures were reviewed and data regarding mortality of mono -drug treatment with different antibiotics were collected . All data were pooled using the technique of meta-analysis by Revman 5 .3 , and heterogeneity tests were performed .Results Eleven articles containing 1620 patients were included . Escherichia coli and K lebsiella pneumonia were the main pathogens ,and there were 31 cases caused by Enterobacter cloacae .There was no statistically significant difference in mortality between carbapenems and piperacillin-tazobactam mono-therapy for the empirical treatment (RR = 0 .86 ;95％ CI :0 .62 - 1 .20 , P> 0 .05) or for definitive treatment (RR = 0 .63 ;95％ CI :0 .20 - 1 .97 ,P > 0 .05) .Carbapenems were used as the main antibiotics for definitive treatment as well as empirical treatment . Conclusion Piperacillin-tazobactam treatment is not associated with increased mortality of the patients with ESBL -positive enterobacteria bloodstream infection ,which can be used as an alternative antibiotics .
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