Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis
Autor(a) principal: | |
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Data de Publicação: | 2014 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1186/1471-2334-14-445 http://hdl.handle.net/11449/117311 |
Resumo: | Background: The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated.Results: A total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82-0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57-0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69-0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences.Conclusion: We showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol. |
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Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysisPeritonitisPeritoneal dialysisTreatmentMeta-analysisBackground: The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated.Results: A total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82-0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57-0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69-0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences.Conclusion: We showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)UNESP Univ Estadual Paulista, Botucatu Med Sch, Sao Paulo, BrazilUNESP Univ Estadual Paulista, Botucatu Med Sch, Sao Paulo, BrazilBiomed Central LtdUniversidade Estadual Paulista (Unesp)Barretti, Pasqual [UNESP]Pereira Doles, Joao Vitor [UNESP]Pinotti, Douglas Goncalves [UNESP]El Dib, Regina [UNESP]2015-03-18T15:55:48Z2015-03-18T15:55:48Z2014-08-18info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article11application/pdfhttp://dx.doi.org/10.1186/1471-2334-14-445Bmc Infectious Diseases. London: Biomed Central Ltd, v. 14, 11 p., 2014.1471-2334http://hdl.handle.net/11449/11731110.1186/1471-2334-14-445WOS:000341784900001WOS000341784900001.pdf54964119838934790000-0003-4979-4836Web of Sciencereponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPengBmc Infectious Diseases2.6201,576info:eu-repo/semantics/openAccess2023-10-13T06:03:22Zoai:repositorio.unesp.br:11449/117311Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462023-10-13T06:03:22Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
title |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
spellingShingle |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis Barretti, Pasqual [UNESP] Peritonitis Peritoneal dialysis Treatment Meta-analysis |
title_short |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
title_full |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
title_fullStr |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
title_full_unstemmed |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
title_sort |
Efficacy of antibiotic therapy for peritoneal dialysis-associated peritonitis: a proportional meta-analysis |
author |
Barretti, Pasqual [UNESP] |
author_facet |
Barretti, Pasqual [UNESP] Pereira Doles, Joao Vitor [UNESP] Pinotti, Douglas Goncalves [UNESP] El Dib, Regina [UNESP] |
author_role |
author |
author2 |
Pereira Doles, Joao Vitor [UNESP] Pinotti, Douglas Goncalves [UNESP] El Dib, Regina [UNESP] |
author2_role |
author author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Barretti, Pasqual [UNESP] Pereira Doles, Joao Vitor [UNESP] Pinotti, Douglas Goncalves [UNESP] El Dib, Regina [UNESP] |
dc.subject.por.fl_str_mv |
Peritonitis Peritoneal dialysis Treatment Meta-analysis |
topic |
Peritonitis Peritoneal dialysis Treatment Meta-analysis |
description |
Background: The choice of antimicrobials for initial treatment of peritoneal dialysis (PD)-related peritonitis is crucial for a favorable outcome. There is no consensus about the best therapy; few prospective controlled studies have been published, and the only published systematic reviews did not report superiority of any class of antimicrobials. The objective of this review was to analyze the results of PD peritonitis treatment in adult patients by employing a new methodology, the proportional meta-analysis.Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from MEDLINE, EMBASE, and LILACS. The inclusion criteria were: (a) case series and RCTs with the number of reported patients in each study greater than five, (b) use of any antibiotic therapy for initial treatment (e.g., cefazolin plus gentamicin or vancomycin plus gentamicin), for Gram-positive (e.g., vancomycin or a first generation cephalosporin), or for Gram-negative rods (e.g., gentamicin, ceftazidime, and fluoroquinolone), (c) patients with PD-related peritonitis, and (d) studies specifying the rates of resolution. A proportional meta-analysis was performed on outcomes using a random-effects model, and the pooled resolution rates were calculated.Results: A total of 64 studies (32 for initial treatment and negative culture, 28 reporting treatment for Gram-positive rods and 24 reporting treatment for Gram-negative rods) and 21 RCTs met all inclusion criteria (14 for initial treatment and negative culture, 8 reporting treatment for Gram-positive rods and 8 reporting treatment for Gram-negative rods). The pooled resolution rate of ceftazidime plus glycopeptide as initial treatment (pooled proportion = 86% [95% CI 0.82-0.89]) was significantly higher than first generation cephalosporin plus aminoglycosides (pooled proportion = 66% [95% CI 0.57-0.75]) and significantly higher than glycopeptides plus aminoglycosides (pooled proportion = 75% [95% CI 0.69-0.80]. Other comparisons of regimens used for either initial treatment, treatment for Gram-positive rods or Gram-negative rods did not show statistically significant differences.Conclusion: We showed that the association of a glycopeptide plus ceftazidime is superior to other regimens for initial treatment of PD peritonitis. This result should be carefully analyzed and does not exclude the necessity of monitoring the local microbiologic profile in each dialysis center to choice the initial therapeutic protocol. |
publishDate |
2014 |
dc.date.none.fl_str_mv |
2014-08-18 2015-03-18T15:55:48Z 2015-03-18T15:55:48Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1186/1471-2334-14-445 Bmc Infectious Diseases. London: Biomed Central Ltd, v. 14, 11 p., 2014. 1471-2334 http://hdl.handle.net/11449/117311 10.1186/1471-2334-14-445 WOS:000341784900001 WOS000341784900001.pdf 5496411983893479 0000-0003-4979-4836 |
url |
http://dx.doi.org/10.1186/1471-2334-14-445 http://hdl.handle.net/11449/117311 |
identifier_str_mv |
Bmc Infectious Diseases. London: Biomed Central Ltd, v. 14, 11 p., 2014. 1471-2334 10.1186/1471-2334-14-445 WOS:000341784900001 WOS000341784900001.pdf 5496411983893479 0000-0003-4979-4836 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
Bmc Infectious Diseases 2.620 1,576 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
11 application/pdf |
dc.publisher.none.fl_str_mv |
Biomed Central Ltd |
publisher.none.fl_str_mv |
Biomed Central Ltd |
dc.source.none.fl_str_mv |
Web of Science reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
collection |
Repositório Institucional da UNESP |
repository.name.fl_str_mv |
Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
repository.mail.fl_str_mv |
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1799964539736817664 |