Efficacy and safety of carbapenems versus new antibiotics for treatment of adult patients with complicated urinary tract infections: A systematic review and meta-analysis

Abstract

Abstract This systematic review and meta-analysis evaluated the clinical efficacy and safety of carbapenems for the treatment of complicated urinary tract infections (cUTIs) with the comparators being new antibiotics evaluated for this indication. We searched 13 electronical databases for published randomised controlled trials (RCTs) and completed and/or ongoing trials. The search terms were developed by using the PICOS framework. Pooled efficacy estimates of composite cure (clinical success and microbiological eradication) favour the new antibiotic groups, although this is not statistically significant [risk ratio (RR)=0.91; 95% confidence interval (CI); 0.79-1.04]. A pooled estimate examining clinical response alone showed no difference between treatment arms (RR=1.00; 95% CI: 0.96-1.05), however, new antibiotic treatments were superior to carbapenems for microbiological response (RR=0.85; 95% CI: 0.79-0.91). New antibiotic treatments demonstrated a superior microbiological response compared to carbapenems in clinical trials of cUTI, despite an absence of carbapenem resistance. However, it is noteworthy that the clinical response and safety profile of new antibiotics were not different from carbapenems.