Carbapenems vs. alternative β-lactams for the treatment of nosocomial pneumonia: A systematic review and meta-analysis.

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dc.contributor.authorO'Donnell, J Nicholas
dc.contributor.authorRhodes, Nathaniel J
dc.contributor.authorLopez, Jenna
dc.contributor.authorJett, Rebecca
dc.contributor.authorScheetz, Marc H
dc.contributor.orcidhttps://orcid.org/0000-0001-5184-1385
dc.date.accessioned2023-12-01T16:35:00Z
dc.date.available2023-12-01T16:35:00Z
dc.date.issued2018-10
dc.descriptionClick on the Resource Link to access the article (may not be free).en_US
dc.description.abstractBackground: Carbapenems have shown efficacy in treating nosocomial pneumonias in clinical trials despite a reported low lung penetration compared with other β-lactams. Preserving the clinical activity of carbapenems through stewardship efforts is essential. The aim of this review was to identify any differences in outcomes potentially as a function of decreased penetration. Methods: PubMed and the Cochrane Library were systematically searched for clinical trials comparing carbapenems with other anti-pseudomonal β-lactams for treatment of nosocomial pneumonia through to end December 2016. Trials reporting clinical and microbiological outcomes associated with treatment were included. Pediatric studies and those with uneven comparators (e.g., carbapenem vs. combination Gram-negative therapy) were excluded. Fixed effects models were used to evaluate the impact of treatment on the odds of clinical failure, death, or microbiological failure. Results: 252 unique articles were identified; five met inclusion criteria and comprised 640 patients in the carbapenem group and 634 patients in the β-lactam group. No differences in clinical failure (odds ratio [OR] 1.08, 95% confidence interval [CI] [0.81-1.44], I2=16%) or mortality (OR 0.75, CI 0.57-1.11, I2=0%) were noted between groups. Patients infected with P. aeruginosa and treated with imipenem were more likely to experience clinical failure (OR 4.21, CI 1.51-11.12, I2=44%) and to develop resistance to the study carbapenem (OR 2.86, CI 1.08-6.44, I2= 13%) than those treated with alternative β-lactams. Conclusions: No differences in clinical outcomes were observed between carbapenems and non-carbapenem β-lactams in nosocomial pneumonias. Those infected with P. aeruginosa fared worse and were more likely to have resistance develop if they were treated with imipenem. Additional studies are warranted.
dc.description.urihttps://doi.org/10.1016/j.ijantimicag.2018.04.011en_US
dc.identifier.citationO'Donnell JN, Rhodes NJ, Lopez J, Jett R, Scheetz MH. Carbapenems vs. alternative β-lactams for the treatment of nosocomial pneumonia: A systematic review and meta-analysis. Int J Antimicrob Agents. 2018 Oct;52(4):451-458. doi: 10.1016/j.ijantimicag.2018.04.011. Epub 2018 Apr 14. PMID: 29665442.en_US
dc.identifier.issn0924-8579
dc.identifier.other29665442
dc.identifier.urihttps://hdl.handle.net/20.500.14303/445
dc.language.isoenen_US
dc.publisherElsevier Science Publishers
dc.relation.ispartofInternational Journal of Antimicrobial Agents
dc.rightsThis Item is protected by copyright and/or related rights. You are free to use this Item in any way that is permitted by the copyright and related rights legislation that applies to your use. For other uses you need to obtain permission from the rights-holder(s). http://rightsstatements.org/vocab/InC/1.0/
dc.subjectcarbapenemen_US
dc.subjectmeta-analysisen_US
dc.subjectnosocomial pneumoniaen_US
dc.subjectβ-lactamen_US
dc.titleCarbapenems vs. alternative β-lactams for the treatment of nosocomial pneumonia: A systematic review and meta-analysis.
dc.typeArticleen_US
local.departmentprogramDepartment of Pharmacy Practice
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