Efficacy and Safety of Carbapenems vs New Antibiotics for Treatment of Adult Patients With Complicated Urinary Tract Infections: A Systematic Review and Meta-analysis

Abstract

This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems for the treatment of complicated urinary tract infections (cUTIs) with the comparators being new antibiotics evaluated for this indication. We searched 13 electronical databases for published randomised controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed by using the PICOS framework. Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favour the new antibiotic groups, although this is not statistically significant [risk ratio (RR)=0.91; 95% confidence interval (CI); 0.79-1.04]. A pooled estimate examining clinical response alone showed no difference between treatment arms (RR=1.00; 95% CI: 0.96-1.05), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR=0.85; 95% CI: 0.79-0.91). New antibiotic treatments demonstrated a superior microbiological response compared to carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from carbapenems.

Efficacy and safety of piperacillin–tazobactam compared with meropenem in treating complicated urinary tract infections including acute pyelonephritis due to extended-spectrum β-lactamase-producing Enterobacteriaceae

“…However, the increased use of carbapenems may lead to the selection of carbapenem resistance in Gram-negative bacilli and the spread of carbapenemase-encoding antibiotic resistance genes ( Mendes et al., 2018 ). To avoid serious outcomes and achieve appropriate prescriptions, many studies have compared carbapenems with other antibacterials ( Chen et al., 2018 ; Sternbach et al., 2018 ; Zhong et al., 2018 ; Ezure et al., 2022 ). In these meta-analyses, carbapenems present similar clinical efficacies and possibly better microbiological responses than other antibacterial agents.…”

Current and Emerging Treatment Options for Multidrug Resistant Escherichia coli Urosepsis: A Review

“…A 2019 randomised clinical trial comparing ceftazidime-avibactam against the best available therapy (BAT) showed that clinical cure rates between the two were similar (80.0% ceftazidime-avibactam, 89.5% BAT) [ 74 ]. A 2020 systematic review of six randomised controlled trials showed that pooled data of ceftazidime-avibactam, cefiderocol, plazomicn and eravacycline was superior to carbapenems in composite cure, a combination of clinical success and microbiological eradication, though not statistically significantly so [ 75 ]. However, a 2021 systematic review and meta-analysis of six randomised controlled trials showed that ceftolozane-tazobactam and ceftazidime-avibactam had a lower clinical and microbiological success rate when compared to carbapenems [ 76 ].…”

Evaluation of the efficacy of the antimicrobial peptide HJH-3 in chickens infected with Salmonella Pullorum

“…Although antibiotics are essential to ensure global health, their overuse and misuse are associated to the arise of “multidrug-resistant strains” ( Robles-Jimenez et al, 2021 ; Ghimpeteanu et al, 2022 ). Although many kinds of “new antimicrobials,” such as second-, third-, and fourth-generation penicillins, have been discovered and developed successively in humans, researchers have not developed new antibiotics of real significance, and the continuous emergence of drug-resistant bacteria and the problem of antibiotic residues seriously threaten human health ( Dutescu and Hillier, 2021 ; Ezure et al, 2022 ). Bacterial antimicrobial resistance has emerged as one of the leading public health threats of the 21st century.…”