用于发热性中性粒细胞减少症经验性治疗的抗假单胞菌β-内酰胺酶的比较：系统评价和网络荟萃分析。

OBJECTIVES:

Compare the effectiveness and safety of antipseudomonal beta-lactam empiric monotherapy for febrile neutropenia by network meta-analysis.

METHODS:

The searches using Pubmed, Cochrane CENTRAL, EMBASE, and Web of Science Core Collection were carried out in June 2016. English articles, non-English articles, full-length articles, short articles, and conference abstracts were allowed. Eligible trial design was a parallel-group individual randomization. We included febrile neutropenia adult and pediatric patients undergoing chemotherapy for either solid tumors or hematological malignanciesand treated with intravenous antipseudomonal beta-lactams for initial empiric therapy. Protocol was registered with PROSPERO ID 42016043377.

RESULTS:

Of 1275 articles detected by the search, 50 studies with 10872 patients were finally included. Among guideline-recommended Cefepime, Meropenem, Imipenem/Cilastatin, Piperacillin/Tazobactam, and Ceftazidime; Imipenem/Cilastatin showed the highest odds of treatment success without modification, which was the primary endpoint, based on the random-effect model network analysis. Ceftazidime was related to lower treatment success rate without modification compared to Imipenem/Cilastatin with odds ratio (OR) of 0.71 (95%CI 0.57-0.89, P = 0.006). Imipenem/Cilastatin showed the lowest odds of all-cause death. Patients treated by Cefepime had higher risk for all-cause death compared to those treated by Imipenem/Cilastatin (OR 2.05, 95%CI 1.11-3.78, P = 0.029). Any adverse event was significantly more prevalent in Imipenem/Cilastatin arm; however, there was no difference concerning adverse event leading to discontinuation.

CONCLUSIONS:

Imipenem/Cilastatin, Piperacillin/Tazobactam, and Meropenem may be reasonable first-choice medications for empiric therapy of febrile neutropenia.