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Carbapenem-sparing beta-lactam/beta-lactamase inhibitors versus carbapenems for bloodstream infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: a systematic review and meta-analysis: Running title: Carbapenem efficacy against extended-spectrum beta-lactamase-producing Enterobacteriaceae

Int J Infect Dis. 2023 Jan 5:S1201-9712(23)00001-2. doi: 10.1016/j.ijid.2023.01.001. Online ahead of print.


OBJECTIVE: Bloodstream infections (BSIs) caused by ESBL-producing Enterobacteriaceae (ESBL-PE) has become a global public health threat, and beta-lactam/beta-lactamase inhibitor combinations (BLBLIs) are considered as one reliable carbapenem-sparing antibiotic. But it’s still controversial whether BLBLIs is truly non-inferior to carbapenems. Therefore, we conducted this meta-analysis to compare efficacy of BLBLIs with carbapenems for ESBL-PE BSIs.

METHODS: A systematic search of PubMed, Cochrane Library and Embase was conducted until December 2021 to enroll studies comparing BLBLIs with carbapenems for ESBL-PE BSIs. Subgroups analysis was performed based on the choice of therapy (empirical, definitive, and mixed therapy). The protocol was registrated in PROSPERO (#CRD42022316011).

RESULTS: 2,786 patients from one randomized clinical trial (RCT) and 25 cohorts were included. There was no statistically difference between BLBLIs and carbapenems groups in therapeutical response (OR=1.19, P=0.45) and mortality (OR=1.06, P=0.68). Furthermore, although statistical difference was also not found in subgroup analysis, BLBLIs performed better in definitive therapy than empirical therapy when compared with carbapenems, with a numerically higher therapeutical response (OR=1.42 vs 0.89) and a mildly lower mortality (OR=0.85 vs 1.14).

CONCLUSIONS: BLBLIs was non-inferior to carbapenems for ESBL-PE BSIs, especially in definitive therapy. BLBLIs may be a valid alternative to spare the use of carbapenems.

PMID:36621752 | DOI:10.1016/j.ijid.2023.01.001

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