Non-carbapenem beta-lactam/beta-lactamase inhibitors versus carbapenems for urinary tract infections caused by extended-spectrum beta-lactamase-producing Enterobacteriaceae: a systematic review.

Abstract

OBJECTIVE\nThe systematic review was conducted to compare the efficacy of non-carbapenem beta-lactam/beta-lactamase inhibitors (BLBLIs) versus carbapenems for the treatment of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) induced urinary tract infections (UTIs).\n\n\nMETHODS\nA comprehensive search of the Cochrane Library, PubMed and Embase was conducted from January 1979 to December 2020. Clinical success, microbiologic success, clinical and microbiologic success, and mortality were assessed as efficacy outcomes. I2 statistic was calculated for heterogeneity, and the fixed-effects or random-effects model was applied for estimation of risk ratio (RR).\n\n\nRESULTS\nA total of 1,612 patients from three randomized clinical trials (RCTs) and seven cohorts were included in the present meta-analysis. There was no statistically significant difference between BLBLIs and carbapenems in clinical success (RR=0.99, P=0.71), clinical and microbiologic success (RR=0.97, P=0.46), and mortality (RR=0.63, P=0.22). Furthermore, a slightly higher rate of microbiologic success has been found in BLBLIs group (RR=1.06, P=0.01), which was mainly attributed to the efficacy of ceftazidime-avibactam based on a single RCT.\n\n\nCONCLUSIONS\nBLBLIs were not inferior to carbapenems with a higher microbiologic success, indicating an effective alternative non-carbapenem option for the treatment of UTIs caused by ESBL-PE. More high-quality and large-scale RCTs are still needed to further validate the findings.