What is the writers overall purpose and intent

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Reference no: EM133870282

Assignment:

Clinical cure rate and cost-effectiveness of carbapenem sparing beta-lactams versus meropenem for Gram-negative infections: a systematic review, meta-analysis, and cost-effectiveness analysis.

Increasing infections caused by extended-spectrum beta-lactamase (ESBL)/AmpC-producing bacteria lead to more use carbapenems and risk of carbapenem resistance. Alternatives are available, but the evidence of treatment success of carbapenem sparing beta-lactams (CSBs) for ESBL infections is unclear. This study aimed to appraise the clinical cure rate and estimate the cost-effectiveness of meropenem versus CSBs (piperacillin-tazobactam, temocillin, ceftazidime-avibactam, and ceftolozane-tazobactam) for urinary tract infections (UTIs) or intra-abdominal infections (IAIs) due to ESBL/AmpC-producing bacteria. A systematic literature search was conducted to identify studies assessing the clinical cure rate of the antibiotics in Cochrane library, EMBASE, PubMed, and Web of Science.

To assess the cost-effectiveness of the CSBs versus meropenem, a combined decision analytic and Markov model was probabilistically analyzed over a 5-year period. The main outcome was presented as the incremental cost-effectiveness ratio and evaluated with a threshold of €20,000 per life year gained (LYG). From 656 identified articles, 17 and 14 studies were included in the qualitative synthesis and quantitative synthesis, respectively. A clinical cure of ceftazidime-avibactam and ceftolozane-tazobactam was comparable with meropenem in patients with complicated IAIs (cIAIs) due to ESBL (Risk ratio = 1•04, 95%CI= 0•95-1•13). Both temocillin and ceftolozane-tazobactam were deemed cost-effective when compared to meropenem with €157•58 and €13,398•34 per LYG, respectively, in patients with UTIs due to ESBL. However, only ceftazidime-avibactam (plus metronidazole) was cost-effective for the treatment of IAIs with €16,916•77 per LYG. Our results reveal that several CSBs can be considered as viable candidates for the treatment of UTIs and IAIs caused by ESBL.

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Reference no: EM133870282

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