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. 2020 Jan;99(2):e18769.
doi: 10.1097/MD.0000000000018769.

Carbapenems vs alternative antibiotics for the treatment of complicated urinary tract infection: A systematic review and network meta-analysis

Xinmei Tan  1 , Qiwen Pan  2 , Changgan Mo  3 , Xianshu Li  4 , Xueyan Liang  4 , Yan Li  4 , Yingnian Lan  1 , Lingyuan Chen  4
Affiliations

Carbapenems vs alternative antibiotics for the treatment of complicated urinary tract infection: A systematic review and network meta-analysis

Xinmei Tan et al. Medicine (Baltimore). 2020 Jan.

Abstract

Background: Complicated urinary tract infections (cUTI) are universal reasons for hospitalization, and highly likely to develop into sepsis or septic shock. Carbapenem antibiotics with potentially higher efficacy or with fewer and milder side effects have increased in popularity, but evidence is limited by a scarcity of randomized controlled trials (RCTs) comparing different carbapenem antibiotics for cUTI. Network meta-analysis is a useful tool to compare multiple treatments when there is limited or no direct evidence available.

Objective: The aim of this study is to compare the efficacy and safety of different carbapenems with alternative antibiotics for the treatment of cUTI.

Methods: Pubmed, Medline, CENTRAL, and Embase were searched in November 2018. Studies of cUTI patients receiving carbapenem were included. We performed network meta-analysis to estimate the risk ratio (RR) and 95% credible interval (CrI) from both direct and indirect evidence; traditional meta-analysis was also performed. Primary outcomes were clinical and microbiological treatment success.

Results: A total of 19 studies and 7380 patients were included in the analysis. Doripenem (DOPM) was associated with lower clinical treatment success rates than other carbapenems. Although the efficacy of other carbapenems by RRs with 95% CrIs did not show statistical differences, the cumulative rank probability indicated that meropenem/vaborbactam (MV), ertapenem (ETPM), and biapenem (BAPM) had higher clinical and microbiological treatment success rates; imipenem/cilastatin (IC) and MV showed higher risk of adverse events (AEs).

Conclusions: MV was associated with higher treatment success rates for cUTI, especially for cUTI caused by carbapenem-resistant uropathogens, but also with higher risk of AEs. Our findings suggest MV as a first-choice treatment of carbapenem-resistant cUTI. ETPM, BAPM, and meropenem (MEPM) is another reasonable choice for cUTI empiric therapy.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Selection process for the studies included in the meta-analysis.
Figure 2
Figure 2
Network comparisons of studies included in the analyses. (A) clinical treatment success; (B) microbiological treatment success.
Figure 3
Figure 3
The effect of carbapenems vs alternative antimicrobial agents on clinical treatment success.
Figure 4
Figure 4
The effect of carbapenems vs alternative antimicrobial agents on microbiological treatment success.
Figure 5
Figure 5
Rank probabilities and cumulative rank plots for effective outcomes. (A) rank probability for clinical treatment success; (B) cumulative rank plot for clinical treatment success; (C) rank probability for microbiological treatment success; (D) cumulative rank plot for microbiological treatment success; (E) rank probability for adverse events; (F) cumulative rank plot for adverse events.
Figure 6
Figure 6
Comparison between direct and indirect evidence, (A) clinical treatment success, (B) microbiological treatment success.
See this image and copyright information in PMC

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