摘要
目的系统评价替考拉宁与万古霉素治疗重症革兰氏阳性菌感染的疗效与安全性。方法计算机检索CBM、CNKI、VIP、WanFang Data、PubMed、EMbase、h e Cochrane Library(2013年第3期)和Springer数据库,收集国内外公开发表的替考拉宁与万古霉素治疗重症革兰氏阳性菌感染的随机对照试验(RCT),检索时限均为从建库至2013年10月。由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价纳入研究的方法学质量后,采用RevMan 5.2软件进行Meta分析。结果最终纳入20个RCT,共1 555例重症革兰阳性菌感染患者。Meta分析结果显示,替考拉宁组与万古霉素组在全因死亡率[OR=1.67,95%CI(0.86,3.23),P=0.13]、治愈率[OR=1.24,95%CI(0.95,1.60),P=0.11]、有效率[OR=1.03,95%CI(0.75,1.41),P=0.87]、细菌清除率[OR=0.96,95%CI(0.66,1.39),P=0.83]方面差异无统计学意义,但替考拉宁组不良反应发生率比万古霉素组低,两组差异有统计学意义[OR=0.50,95%CI(0.34,0.72),P=0.000 2]。结论本Meta分析结果显示,替考拉宁治疗重症革兰阳性菌感染与万古霉素疗效相似,但安全性更好。受纳入研究数量和质量所限,上述结论仍需要更多高质量的研究进一步验证。
Objective To systematically review the therapeutic effects and safety of teicoplanin versus vancomycin for severe gram-positive bacterial infection. Methods We electronically searched CBM, CNKI, VIP, WanFang Data, PubMed, EMbase, The Cochrane Library （Issue 3, 2013） and Springer for the internationally-nationally published randomized controlled trials （RCTs） on teicoplanin versus vancomycin for severe gram-positive bacterial infections from inception to October 2013. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2 software. Results Twenty RCTs were finally included, involving 1 555 patients with severe gram-positive bacterial infection. The results of meta-analysis showed that there was no significant difference between teicoplanin and vancomy- cin with regard to all-cause mortality （OR=1.67, 95%CI 0.86 to 3.23, P=0.13）, clinical cure rates （OR=1.24, 95%CI 0.95 to 1.60, P=0.11）, effective rates （OR=1.03, 95%CI 0.75 to 1.41, P=0.87）, and bacterial clearance rates （OR=0.96, 95%CI 0.66 to 1.39, P=0.83）. However, the incidence of adverse reaction was lower in the teicoplanin group than in the vancomycin with a significant difference （OR=0.S0, 95%CI 0.34 to 0.72, P=0.000 2）. Conclusion The results of meta-analysis shows that, teicoplanin is similar to vancomycin in therapeutic effects on treating severe gram-positive bacterial infection hut it is better in safety. However, because of limited quantity and quality of the included studies, the above conclusion needs to be further verified by conducting more high-quality studies.
出处
《中国循证医学杂志》
CSCD
2014年第7期841-848,共8页
Chinese Journal of Evidence-based Medicine
关键词
万古霉素
替考拉宁
多重耐药
系统评价
Meta分析
随机对照试验
Vancomycin
Teicoplanin
Multiple drug resistance
Systematic review
Meta-analysis
Randomizedcontrolled trial
