Comparison of ceftolozane-tazobactam and ceftazidime-avibactam for the treatment of infections caused by drug-resistant Pseudomonas aeruginosa: an updated systematic review and meta-analysis based on adjusted data from observational studies.
临床指南推荐两种新型β-内酰胺/β-内酰胺酶抑制剂复方制剂——头孢洛扎-他唑巴坦和头孢他啶-阿维巴坦——作为耐药铜绿假单胞菌感染的一线治疗药物。本研究旨在比较两者的疗效、安全性及耐药性的出现情况。研究采用系统评价和荟萃分析方法。主要分析基于直接比较的校正数据。为评估结果的稳健性，将这些发现与未校正的直接和间接比较的合并估计值进行了对比。结局指标包括全因死亡率、临床应答、病原体清除、复发性感染、急性肾损伤（AKI）及体内耐药性的出现。采用ROBINS-I工具基于预设混杂因素评估偏倚风险。共纳入22项研究，涉及3361例患者。两种药物在全因死亡率、临床应答、急性肾损伤及耐药性出现方面未观察到显著差异。然而，与头孢他啶-阿维巴坦相比，头孢洛扎-他唑巴坦与30至90天内复发性感染风险降低相关（aOR = 0.46，95% CI：0.26-0.78）。头孢洛扎-他唑巴坦和头孢他啶-阿维巴坦显示出相当的疗效和相似的耐药性出现风险。中等确定性证据表明，头孢洛扎-他唑巴坦可能降低耐药铜绿假单胞菌感染患者的复发性感染风险。
Clinical guidelines recommend two novel β-lactam/β-lactamase inhibitor combinations-ceftolozane-tazobactam and ceftazidime-avibactam-as first-line therapies for drug-resistant Pseudomonas aeruginosa infections. This study aimed to compare their efficacy, safety, and emergence of resistance. A systematic review and meta-analysis was conducted. The primary analysis was based on adjusted data from direct comparisons. To assess robustness, these findings were compared with pooled estimates from unadjusted direct and indirect comparisons. Outcomes included all-cause mortality, clinical response, pathogen clearance, recurrent infection, AKI, and in vivo emergence of resistance. Risk of bias was assessed using the ROBINS-I tool based on prespecified confounders. Twenty-two studies including 3361 patients were analyzed. No significant differences were observed between the two agents in all-cause mortality, clinical response, AKI, and emergence of resistance. However, ceftolozane-tazobactam was associated with a lower risk of recurrent infection within 30-90 days compared with ceftazidime-avibactam (aOR = 0.46, 95% CI: 0.26-0.78). Ceftolozane-tazobactam and ceftazidime-avibactam demonstrate comparable efficacy and similar risks of resistance emergence. Moderate-certainty evidence suggests that ceftolozane-tazobactam may reduce the risk of recurrent infection in patients with drug-resistant P. aeruginosa infections.
Pengfei Li, Ping Zhang, Xuefeng Shan, Jiaoni Zheng. Comparison of ceftolozane-tazobactam and ceftazidime-avibactam for the treatment of infections caused by drug-resistant Pseudomonas aeruginosa: an updated systematic review and meta-analysis based on adjusted data from observational studies.. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. 2026; doi:10.1016/j.ijid.2026.108809.
Pengfei Li, Ping Zhang, Xuefeng Shan, Jiaoni Zheng (2026). Comparison of ceftolozane-tazobactam and ceftazidime-avibactam for the treatment of infections caused by drug-resistant Pseudomonas aeruginosa: an updated systematic review and meta-analysis based on adjusted data from observational studies.. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. https://doi.org/10.1016/j.ijid.2026.108809
Pengfei Li, Ping Zhang, Xuefeng Shan, Jiaoni Zheng. Comparison of ceftolozane-tazobactam and ceftazidime-avibactam for the treatment of infections caused by drug-resistant Pseudomonas aeruginosa: an updated systematic review and meta-analysis based on adjusted data from observational studies.[J]. International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases, 2026 doi:10.1016/j.ijid.2026.108809.
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