{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T07:14:23Z","timestamp":1763968463564,"version":"build-2065373602"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T00:00:00Z","timestamp":1623888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Overuse of carbapenems has led to the increasing carbapenem-resistant <jats:italic>Enterobacteriaceae<\/jats:italic>. It is still unknown whether other antibiotics [especially novel <jats:italic>\u03b2<\/jats:italic>-lactam\/\u03b2-lactamase inhibitor combinations (BL\/BLIs)] are better than carbapenems in the treatment of <jats:italic>Enterobacteriaceae<\/jats:italic>. A systematic literature search was performed to identify randomized controlled trials (RCTs) assessing the efficacy and safety of any antibiotics on <jats:italic>Enterobacteriaceae<\/jats:italic> infections. We carried out a traditional paired meta-analysis to compare ceftazidime\/avibactam to comparators. Network meta-analysis (NMA) was conducted to integrate direct and indirect evidence of all interventions. Moreover, cost-effectiveness analysis using a combined decision analytical Markov model was completed for the treatment of patients with complex urinary tract infection (cUTI). A total of 25 relevant RCTs were identified, comprising 15 different interventions. Ceftazidime\/avibactam exhibited comparable efficacy and safety with comparators (carbapenems) in the paired meta-analysis. In the NMA, the surface under the cumulative ranking curve probabilities showed that in terms of efficacy, the interventions with the highest-ranking were meropenem\/vaborbactam, meropenem, imipenem\/cilastatin, ceftriaxone, ceftazidime\/avibactam, and ceftolozane\/tazobactam [but no significant difference between any two antibiotics (<jats:italic>p<\/jats:italic> &amp;gt; 0.05)]. Regarding safety, ceftazidime\/avibactam had a higher incidence of adverse events than that of piperacillin\/tazobactam (relative risk = 0.74, 95% confidence interval = 0.59\u20130.94). Based on drug and hospitalization costs in China, the incremental cost-effectiveness ratio per quality-adjusted life-year gained in the patients with cUTI for meropenem, ceftazidime\/avibactam, and ceftolozane\/tazobactam compared to imipenem\/cilastatin were US$579, US$24569, and US$29040, respectively. The role of these BL\/BLIs to serve as alternatives to carbapenems requires large-scale and high-quality studies to validate.<\/jats:p>","DOI":"10.3389\/fphar.2021.656790","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T05:31:16Z","timestamp":1623907876000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Choosing Optimal Antibiotics for the Treatment of Patients Infected With Enterobacteriaceae: A Network Meta-analysis and Cost-Effectiveness Analysis"],"prefix":"10.3389","volume":"12","author":[{"given":"Ruiying","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengmeng","family":"Teng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taotao","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaojiao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sihan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaling","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yalin","family":"Dong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1136\/bmj.331.7521.897","article-title":"Simultaneous Comparison of Multiple Treatments: Combining Direct and Indirect Evidence","volume":"331","author":"Caldwell","year":"2005","journal-title":"Bmj"},{"key":"B2","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/s1473-3099(16)30004-4","article-title":"Ceftazidime-avibactam or Best Available Therapy in Patients with Ceftazidime-Resistant Enterobacteriaceae and Pseudomonas aeruginosa Complicated Urinary Tract Infections or Complicated Intra-abdominal Infections (REPRISE): a Randomised, Pathogen-Directed, Phase 3 Study","volume":"16","author":"Carmeli","year":"2016","journal-title":"Lancet Infect. 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