Meta-analysis of a possible signal of increased mortality associated with cefepime use
| Autor: | Yu-te Wu, Charles K. Cooper, Sumathi Nambiar, Yan Wang, Thamban Valappil, Cynthia Kornegay, George Rochester, Peter W. Kim |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Microbiology (medical)
Adult Male Pediatrics medicine.medical_specialty Neutropenia Adolescent Cefepime Population Fever of Unknown Origin Young Adult medicine Pneumonia Bacterial Humans education Adverse effect Child Antibacterial agent Aged Aged 80 and over education.field_of_study Clinical Trials as Topic business.industry Mortality rate Infant Newborn Infant Bacterial Infections Skin Diseases Bacterial Middle Aged medicine.disease Survival Analysis Confidence interval Anti-Bacterial Agents Cephalosporins Clinical trial Infectious Diseases Child Preschool Urinary Tract Infections Female business Febrile neutropenia medicine.drug |
| Zdroj: | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 51(4) |
| ISSN: | 1537-6591 |
| Popis: | Background On the basis of meta-analyses, concern has been raised regarding a possible signal of increased mortality associated with the use of cefepime versus other beta-lactam antibiotics. To further investigate this possible signal, we accessed findings and data from published and unpublished cefepime clinical trials. Methods We performed meta-analyses using trial- and patient-level data from comparative trials. Trial-level analyses were performed using summary data from all patients in the trials, and patient-level analyses were performed on trials for which patient-level data were available. Thirty-day, all-cause mortality was analyzed using the Mantel-Haenszel adjusted risk difference (ARD) method. Results The trial-level meta-analysis was based on 88 trials (9467 cefepime patients and 8288 comparator patients). The 30-day, all-cause mortality rates were 6.21% (588/9467) for the cefepime patients and 6.00% (497/8288) for comparator patients (ARD per 1000 population, 5.38; 95% confidence interval [CI], -1.53 to 12.28). In the patient-level analysis (35 trials, 5058 cefepime patients, and 3976 comparator patients), 30-day, all-cause mortality rates were 5.63% (285/5058) for cefepime patients and 5.68% (226/3976) for comparator patients (ARD per 1000 population, 4.83; 95% CI, -4.72 to 14.38). A sensitivity analysis based solely on the 24 febrile neutropenia trials did not show a statistically significant increase in mortality with cefepime use (ARD per 1000 population, 9.67; 95% CI, -2.87 to 22.21). Conclusions In both trial-level and patient-level meta-analyses, we did not identify a statistically significant increase in mortality among cefepime-treated patients, compared with those treated with other antibacterials. |
| Databáze: | OpenAIRE |
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