Empiric antibiotics for community-acquired pneumonia in adult patients: a systematic review and a network meta-analysis

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2019-214054
Author(s):  
Lara Montes-Andujar ◽  
Elena Tinoco ◽  
Orville Baez-Pravia ◽  
Carlos Martin-Saborido ◽  
Pablo Blanco-Schweizer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mortality Rate ◽  
Meta Analysis ◽  
R Package ◽  
Community Acquired Pneumonia ◽  
Risk Of Bias ◽  
Adult Patients ◽  
Measurement Tool ◽  
Cure Rate ◽  
Hospitalised Patients

ObjectiveThe main aim of this network meta-analysis is to identify the empiric antibiotic (Em-ATB) with the highest probability of being the best (HPBB) in terms of (1) cure rate and (2) mortality rate in hospitalised patients with community acquired pneumonia (CAP) .MethodInclusion criteria: (1) adult patients (>16 years old) diagnosed with CAP that required hospitalisation; (2) randomised to at least two different Em-ATBs, (3) that report cure rate and (4) are written in English or Spanish. Exclusion criteria: (1) ambiguous antibiotics protocol and (2) published exclusively in abstract or letter format. Data sources: Medline, Embase, Cochrane and citation reviews from 1 January 2000 to 31 December 2018. Risk of bias: Cochrane’s tool. Quality of the systematic review (SR): A MeaSurement Tool to Assess systematic Reviews-2. Certainity of the evidence: Grading of Recommendations Assessment, Development and Evaluation. Statistical analyses: frequentist method performed with the ‘netmeta’ library, R package.Results27 randomised controlled trials (RCTs) from the initial 41 307 screened citations were included. Regarding the risk of bias, more than one quarter of the studies presented low risk and no study presented high risk in all domains. The SR quality is moderate. For cure, two networks were constructed. Thus, two Em-ATBs have the HPBB: cetaroline 600 mg (two times a day) and piperacillin 2000 mg (two times a day). For mortality, three networks were constructed. Thus, three Em-ATBs have the HPBB: ceftriaxone 2000 mg (once a day) plus levofloxacin 500 (two times a day), ertapenem 1000 mg (two times a day) and amikacin 250 mg (two times a day) plus clarithromycin 500 mg (two times a day). The certainity of evidence for each results is moderate.ConclusionFor cure rate, ceftaroline and piperaciline are the options with the HPBB. However, for mortality rate, the options are ceftriaxone plus levofloxacin, ertapenem and amikacin plus clarithromycin. It seems necessary to conduct an RCT that compares treatments with the HPBB for each event (cure or mortality) (CRD42017060692).

scholarly journals Protocol for a systematic review and network meta-analysis of the management of new onset atrial fibrillation in critically unwell adult patients

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Brian W. Johnston ◽  
Ruaraidh Hill ◽  
Rui Duarte ◽  
Chung Shen Chean ◽  
Danny F. McAuley ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
R Package ◽  
Risk Of Bias ◽  
Adult Patients ◽  
Cochrane Central Register ◽  
Randomised Trials ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New onset atrial fibrillation is the most commonly encountered arrhythmia in critically unwell patients with a reported incidence of 4% to 29%. The occurrence of new onset atrial fibrillation may precipitate acute heart failure and lead to thromboembolic complications as well as being associated with increased in-hospital and in intensive care unit (ICU) mortality. Despite being common, much of our current knowledge regarding the treatment of new onset atrial fibrillation comes from patients with chronic atrial fibrillation or post cardiac surgery. It is unclear if management strategies in these patient cohorts can be applied to new onset atrial fibrillation in the general ICU. This protocol for a systematic review and network meta-analysis aims to address this uncertainty and define what is the most effective management strategy for the treatment of new onset atrial fibrillation (NOAF) in acutely unwell adult patients. Methods In this systematic review and network meta-analysis, we plan to search electronic databases (Cochrane Central Register of Controlled Trials [CENTRAL], MEDLINE, EMBASE, Science Citation Index Expanded on Web of Science and relevant trial registries) for relevant randomised and non-randomised trials. Citations will be reviewed by title, abstract and full text by two independent reviewers and disagreement resolved by discussion and a third independent reviewer, if necessary. The Cochrane Risk of Bias tool will be used to assess risk of bias in randomised trials and the Risk of Bias in Nonrandomised Studies of Interventions (ROBINS-I) tool will be used for non-randomised studies. Statistical analysis will be carried out using R package meta and netmeta. We will first conduct a pairwise meta-analysis. If conditions for indirect comparison are satisfied and suitable data are available, we will conduct network meta-analysis using frequentist methodology. Treatments will be ranked according to efficacy with associated P-scores. We will assess the quality of the evidence in the pairwise using GRADE methodology and network meta-analysis comparisons in the CINeMA module in R package meta. Discussion Our review will be the first to assess direct and indirect evidence to assess the efficacy and rank the treatments available for new onset atrial fibrillation in critically unwell patients. Our review findings will be applicable to the care of people in a range of acute settings including, ICU, the emergency department and acute medical units. Systematic review registration PROSPERO registry number: CRD42019121739.

scholarly journals The effect of double-carbapenem therapy on mortality rates and microbiological cure rates in patients diagnosed with carbapenem-resistant Klebsiella pneumoniae infections in comparison to monotherapy and currently used combinations of antibiotics

2021 ◽  
Vol 5 (1) ◽  
pp. e000243
Author(s):  
Rhiannon Olivia Moody
Keyword(s):  
Mortality Rate ◽  
Klebsiella Pneumoniae ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Resistant Bacteria ◽  
Cure Rate ◽  
Treatment Regimens ◽  
Hospitalised Patients ◽  
Microbiological Cure

Introduction: Infection with the bacteria carpamenease-producing Klebsiella pneumoniae represents a significant cause of mortality in hospitalised patients. These multidrug resistant bacteria are resistant to currently used antibiotics as a result of carbapenemase production. Dual carbapenem therapy has been proposed as a valid therapeutic option, this therapy combines two carbapenem antibiotics, with one acting as a suicide inhibitor allowing the subsequent carbapenem to exert a bactericidal effect. Aim: The aim of this meta-analysis was to determine if dual carbapenem therapy had a significant effect on mortality rate and microbiological cure rate in patients diagnosed with carbapenemase-producing Klebsiella pneumoniae infections in comparison to standard antibiotic therapies. Methods: The search terms “(dual OR double) carbapenem (therapy OR treatment) AND klebsiella pneumoniae” were used to search databases and inclusion and exclusion criteria were applied to retrieved papers, a total of seven studies were identified for inclusion in the meta-analysis. The quality of included studies was assessed using the cochrane tool for risk of bias assessment and funnel plots were produced to determine the influence of publication bias. A random effects model was used to assess the outcomes; mortality rate and microbiological cure rate. Results and Conclusion: Dual carbapenem therapy had a time dependent effect on patient mortality rates. Dual carbapenem therapy significantly lowered  mortality rates in patients in comparison to standard antibiotic therapy, especially in comparison to monotherapy treatment regimens. Additionally, dual carbapenem therapy significantly improved microbiological cure rate in patients when compared to standard antibiotic treatment regimens demonstrating the possible clinical applications of a dual carbapenem antibiotic regimen in the treatment of carbapenemase-producing Klebsiella pneumoniae infections. 

scholarly journals Balanced crystalloids compared to normal saline for fluid therapy in critically ill adult patients: Systematic review and meta-analysis protocol

2021 ◽  
Author(s):  
Naomi E Hammond ◽  
Fernando G Zampieri ◽  
Tessa Garside ◽  
Derek Adigbli ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Fluid Therapy ◽  
Normal Saline ◽  
Meta Analysis ◽  
Scientific Journal ◽  
Risk Of Bias ◽  
Adult Patients ◽  
Primary Data ◽  
Salt Solutions

Introduction The choice of intravenous fluid for fluid therapy in critically ill adult patients remains a matter of debate. Currently, crystalloids are used more often than colloids, with ongoing controversy over the relative efficacy and safety of buffered salt solutions (BSS) versus normal saline (0.9% sodium chloride). In 2021 two large pragmatic trials enrolling critically ill patients will add substantial new data to address this controversy. We will conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) that will include the data from these two trials to provide clinicians with the most up to date evidence and robust evidence to guide their choice of crystalloid fluids. Methods and analysis We will include RCTs that compare the effect of buffered salt solutions to normal saline for fluid resuscitation and/or fluid therapy in critically ill adults, on all-cause mortality and other patient centred outcomes. We will perform a search that includes the electronic databases MEDLINE and EMBASE, and clinical trial registries. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data, with discrepancies resolved by a third reviewer. We will report study characteristics and assess risk of bias using the Cochrane Risk-of-Bias tool. We will perform Hartung-Knapp-Sidik-Jonkman random-effects aggregate data meta-analysis whenever it is feasible to do so. We will evaluate overall certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Ethics and dissemination This systematic review and meta-analysis does not require ethical approval as it does not involve primary data collection. We will publish our results in a peer-reviewed scientific journal and present them at national and international scientific conferences. PROSPERO registration number: CRD42021243399

P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii51-ii52
Author(s):  
A M George ◽  
S Gupta ◽  
S M Keshwara ◽  
M A Mustafa ◽  
C S Gillespie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Neurofibromatosis Type ◽  
Risk Of Bias ◽  
Measurement Tool ◽  
High Quality ◽  
Meta Analyses

Abstract BACKGROUND Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting & methodological quality of meningioma evidence syntheses. MATERIAL AND METHODS Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines. RESULTS 117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring. CONCLUSION Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.

scholarly journals Traditional Chinese Medicine For HIV-Associated Acute Herpes Zoster: A Systematic Review And Meta-Analysis of Randomized Trials

2021 ◽  
Author(s):  
Yue Jiang ◽  
Ruo-xiang Zheng ◽  
Ze-yu Yu ◽  
Xiao-wen Zhang ◽  
Jing Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Herpes Zoster ◽  
Chinese Medicine ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Combination Group ◽  
Cure Rate ◽  
Chinese Herbal ◽  
N 93 ◽  
Better Than

Abstract Background: Herpes zoster (HZ) is a common infection in individuals with immunocompromised immune systems, such as Acquired Immune Deficiency Syndrome (AIDS) patients. Traditional Chinese Medicine (TCM) has been used widely in clinical practice for HZ, which remains not supportive from evidence. This systematic review aimed to evaluate the effectiveness and safety of TCM in treating HIV-associated HZ.Methods: Eight electronic databases, including CNKI, Wanfang, VIP, SinoMed, WHO ICTRP, CENTRAL, PubMed, and clinicaltrials.gov, were searched for randomized controlled trials (RCTs) testing TCM in treating HIV-associated HZ. Data were extracted on citations, study design, interventions, and outcomes. Cochrane risk of bias tool 2.0 were used for quality evaluation. We performed meta-analyses by Revman 5.3 software. Effect estimates were presented as risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data with their 95% confidence interval (CI).Results: Twelve RCTs (644 patients) were included, majority of them had high or unclear risk of bias in terms. The result of meta-analysis showed that, pain intensity (VAS 0-5) in Chinese herbal medicine (CHM) group was lower than it in drugs group (MD=-0.87, 95%CI [-1.69, -0.04], 2 trials, n=93). Duration of herpes related pain (days) of patients in combination group was shorter than those in drugs group (MD=-9.19, 95%CI [-16.73, -1.65], n=144). The incidence of postherpetic neuralgia (PHN) in combination group was lower than it in drugs group (RR = 0.49, 95% CI [0.25, 0.99], n=202). As for cure rate (defined as complete absence of pain and herpes), 2 trials showed that CHM was better than drugs (RR = 1.58 , 95% CI [1.13, 2.22], n=93), 5 trials showed combination treatment was better than drugs (RR = 1.40, 95% CI = [1.08, 1.82], n=224). Cure rate in acupuncture group was more improved than that in drugs group (RR=1.99, 95%CI=[1.18, 3.36], n=120). Four trials reported adverse effects which found no serious adverse events occurred.Conclusion: Chinese herbal medicine and acupuncture demonstrate more benefits than drugs in relieving pain, improving cure rate and reducing incidence of PHN for HIV-associated HZ. However, given to the limited data and various TCM therapies, the conclusions need to be verified in future trials.

scholarly journals Prediction of outcomes after acute kidney injury in hospitalised patients: protocol for a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042035
Author(s):  
Tanima Arora ◽  
Melissa Martin ◽  
Alyssa Grimshaw ◽  
Sherry Mansour ◽  
Francis P Wilson
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Kidney Injury ◽  
Risk Of Bias ◽  
Receiver Operating Curve ◽  
Team Members ◽  
Hospitalised Patients

IntroductionAcute kidney injury (AKI) is common and is associated with negative long-term outcomes. Given the heterogeneity of the syndrome, the ability to predict outcomes of AKI may be beneficial towards effectively using resources and personalising AKI care. This systematic review will identify, describe and assess current models in the literature for the prediction of outcomes in hospitalised patients with AKI.Methods and analysisRelevant literature from a comprehensive search across six databases will be imported into Covidence. Abstract screening and full-text review will be conducted independently by two team members, and any conflicts will be resolved by a third member. Studies to be included are cohort studies and randomised controlled trials with at least 100 subjects, adult hospitalised patients, with AKI. Only those studies evaluating multivariable predictive models reporting a statistical measure of accuracy (area under the receiver operating curve or C-statistic) and predicting resolution of AKI, progression of AKI, subsequent dialysis and mortality will be included. Data extraction will be performed independently by two team members, with a third reviewer available to resolve conflicts. Results will be reported using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Risk of bias will be assessed using Prediction model Risk Of Bias ASsessment Tool.Ethics and disseminationWe are committed to open dissemination of our results through the registration of our systematic review on PROSPERO and future publication. We hope that our review provides a platform for future work in realm of using artificial intelligence to predict outcomes of common diseases.PROSPERO registration numberCRD42019137274.

scholarly journals Does the Use of Botulinum Toxin Reduce the Intensity of Myofascial Pain in Adult Patients? A Systematic Review and Meta-Analysis

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Letícia Maira Wambier
Keyword(s):  
Systematic Review ◽  
Botulinum Toxin ◽  
Pain Relief ◽  
Saline Solution ◽  
Myofascial Pain ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Adult Patients ◽  
Cochrane Library ◽  
Similar Data

Objective: A systematic review was performed to evaluate if the use of botulinum toxin was able to reduce the intensity of myofascial pain compared to other treatments in adult patients. Material and Methods: A comprehensive search was carried out in the MEDLINE via Pub-Meb, Scopus, Web of Science, LILACS, BBO and Cochrane Library. In addition, the gray literature was also researched. The risk of bias tool from the Cochrane Collaboration was used by two independent reviewers for quality assessment of the studies. Results: A total of 4372 studies were identified, 9 remained in qualitative study, 8 of these studies were considered at “unclear” risk of bias and just one study was “low” risk of bias in the key domains. Only two studies presented similar data to be included in the meta-analysis. Both studies evaluated the pain relief used the botulinum toxin (BTX-A) versus saline solution. The meta-analysis demonstrated that after 3 months follow-up the pain relief was 15.70 (95 % confidence interval [CI] = 0.80 to 30.61; p = 0.04). Conclusion: The BTX-A reduced the intensity of myofascial pain compared to saline solution in adults after 3 months. However, further studies should be conducted to corroborate this finding.

scholarly journals The benefits of non-invasive ventilation for community-acquired pneumonia: a meta-analysis

QJM ◽  
2020 ◽  
Author(s):  
G Klefti ◽  
A T Hill
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Community Acquired Pneumonia ◽  
Risk Of Bias ◽  
Invasive Ventilation ◽  
Icu Mortality ◽  
Non Invasive ◽  
Non Invasive Ventilation

Summary There is an observed international increase in non-invasive ventilation (NIV) application as an alternative to endotracheal intubation (ETI) in non-chronic obsructive pulmonary disease (COPD) patients admitted with community-acquired pneumonia (CAP) despite the lack of strong evidence for its use. The aim of this study is the meta-analysis of data from randomized controlled trials (RCTs) on the effectiveness of NIV vs. standard medical care in adults admitted with severe CAP. Monthly electronic searches on CENTRAL and MEDLINE were performed between September 2017 and October 2019. Only RCTs comparing NIV to standard medical care for the treatment of CAP in adults were eligible for inclusion. The primary outcomes were the rate of ETI and the proportion of patients meeting the criteria of ETI as defined by the investigators. Secondary outcomes were the intensive care unit (ICU) and hospital mortality rate. Study eligibility was independently assessed by two investigators. The risk of bias of included studies was assessed using Cochrane’s Risk of bias Tool. Four RCTs involving a total of 218 participants were eligible for inclusion. Results from the meta-analysis showed that NIV significantly reduced rate of ETI (risk ratio (RR) = 0.46, 95% CI [0.26, 0.79]), the proportion of patients that met the criteria for ETI (RR = 0.28, 95% CI [0.16, 0.49]) and ICU mortality rate (RR = 0.3, 95% CI [0.09, 0.93]). No significant effect on hospital mortality rate was found (RR = 0.44, 95% CI [0.05, 3.67]). The authors rated quality of evidence based on GRADE criteria as ‘Moderate’ for the rate of intubation and proportion of patients meeting ETI criteria outcomes, but quality of evidence for ICU and hospital mortality rate as ‘Low’. This study provides evidence supporting the use of NIV as potential means of avoiding ETI and ICU mortality, in patients with acute respiratory failure due to CAP in the critical care setting. However, there is need for further larger international studies.

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