Document Detail


Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia.
MedLine Citation:
PMID:  17329491     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The comparative effectiveness and safety of carbapenems with other beta-lactams and fluoroquinolones for the empirical treatment of patients with hospital-acquired pneumonia remains controversial. In the present study, a meta-analysis of 12 relevant randomised controlled trials was performed. Overall, carbapenems were associated with lower mortality than fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides (odds ratio 0.72, 95% confidence interval 0.55-0.95). There was no difference between the compared antibiotics regarding treatment success (1.08, 0.91-1.29), microbiological success (1.04, 0.72-1.50) or development of adverse effects (0.81, 0.46-1.43). In the subset of patients with Pseudomonas aeruginosa pneumonia, carbapenems were associated with lower treatment success (0.42, 0.22-0.82) and lower eradication of P. strains (0.50, 0.24-0.89). Carbapenems are equivalent to fluoroquinolones or beta-lactams, alone or in combination with aminoglycosides, for the empirical treatment of immunocompetent adult patients with hospital-acquired pneumonia. However, there is limited evidence, based predominantly on unblinded randomised controlled trials, that carbapenems are associated with lower mortality than the comparators; this association was not observed in a subset analysis of randomised controlled trials with a high methodological quality score. In patients with Pseudomonas aeruginosa pneumonia, carbapenems are associated with worse outcomes than the comparators.
Authors:
I I Siempos; K Z Vardakas; K G Manta; M E Falagas
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis    
Journal Detail:
Title:  The European respiratory journal     Volume:  29     ISSN:  0903-1936     ISO Abbreviation:  Eur. Respir. J.     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-03-01     Completed Date:  2007-05-16     Revised Date:  2013-05-23    
Medline Journal Info:
Nlm Unique ID:  8803460     Medline TA:  Eur Respir J     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  548-60     Citation Subset:  IM    
Affiliation:
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
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MeSH Terms
Descriptor/Qualifier:
Acinetobacter Infections / drug therapy,  immunology,  mortality
Acinetobacter baumannii
Adult
Aminoglycosides / adverse effects,  therapeutic use
Carbapenems / adverse effects,  therapeutic use*
Cross Infection / drug therapy*,  immunology,  mortality
Drug Resistance, Multiple
Drug Therapy, Combination
Fluoroquinolones / adverse effects,  therapeutic use
Humans
Immunocompetence / immunology
Intensive Care Units
Pneumonia, Bacterial / drug therapy*,  immunology,  mortality
Pseudomonas Infections / drug therapy,  immunology,  mortality
Randomized Controlled Trials as Topic
Respiration, Artificial
Survival Rate
Thienamycins / adverse effects,  therapeutic use
Treatment Outcome
beta-Lactams / adverse effects,  therapeutic use
Chemical
Reg. No./Substance:
0/Aminoglycosides; 0/Carbapenems; 0/Fluoroquinolones; 0/Thienamycins; 0/beta-Lactams; 96036-03-2/meropenem

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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