成人急性腎盂腎炎併發菌血症或敗血症靜脈抗生素應該使用日數之實證醫學回顧

The Appropriate Duration of Intravenous Antibiotics for Adult Acute Pyelonephritis with Sepsis or Bacteremia: An Evidence-based Review

王道仁(Tao-Jen Wang) ； 郭斐然(Fei-Ran Guo)

《臺灣家庭醫學研究》 5卷3期&4 (2007/10) Pp. 119-125

https://doi.org/10.29475/TFMR.200710.0003

摘要

背景：成人急性腎盂腎炎應使用靜脈抗生素的天數，對住院天數影響很大。如果併發菌血症或敗血症時，靜脈抗生素應使用多久，或是否應比照一般敗血症處理，並無定論。
搜尋策略及文獻選擇：搜尋Cochrane Review，另搜尋MEDLINE中相關的統合分析(meta-analysis)、隨機對照臨床試驗(randomized controlled trial)及比較研究(comparative study)，至2007年7月為止。
文獻分析結果：並無直接探討此問題之統合分析或隨機對照臨床試驗。有一篇回溯性的比較研究指出非大腸桿菌之菌血症可能提高6個月內復發的機率，但其證據等級有限。有一篇統合分析及四篇隨機對照臨床試驗有較多菌血症人數，其中有兩篇隨機對照試驗是比較標準治療和直接使用口服抗生素治療，有兩篇隨機對照試驗是比較標準治療和先打一劑靜脈抗生素後立即換口服，統合分析則是比較兩種抗生素，都是使用大於等於3天的靜脈抗生素治療復換口服中。此5篇的結果都是並無顯著差異，但並未針對菌血症族群做足夠的分析。
結論：目前並沒有足夠證據建議成人急性腎盂腎炎併發菌血症或敗血症時靜脈抗生素應使用多久，仍需更多的研究。若根據專家建議，可考慮使用至退燒，其證據等級為第5級

並列摘要

Background: The duration of intravenous antibiotic for adult acute pyelonephritis with sepsis or bacteremia influences the duration of hospital stay. But there was no consensus on the appropriate duration of intravenous antibiotics.
Search strategy: Search Cochrane Review, MEDLINE until Jul., 2007.
Result: There was neither meta-analysis nor randomized controlled trial (RCT) meets our study topic. One retrospective comparative study found that non-Escherichia coli bacteremia was associated with recurrence of urinary tract infection within 6 months. There was one metaanalysis and four RCTs on the treatment of acute pyelonephritis or urinary tract infection and some of these patients had sepsis or bacteremia. Two of the RCTs compared conventional antibiotic therapy and used oral antibiotic only. Two of the RCTs compared conventional antibiotic therapy and one dose of intravenous antibiotic followed by oral antibiotic. One metaanalysis study compared two studies both giving intravenous antibiotics for more than three days. The four RCTs and the meta-analysis showed no significant differences between study groups and control groups, but no subgroup analysis was conducted on bacteremia or sepsis.
Conclusion: There was insufficient evidence to give recommendation of the appropriate duration of intravenous antibiotics for adult acute pyelonephritis. Further studies are needed. Based on expert's opinion, intravenous antibiotics could be given till the fever subside, and then shift to oral antibiotics. The level of evidence of the above recommendation is level V.

並列關鍵字

acute pyelonephritis ； urinary tract infection ； bacteremia ； sepsis ； antibiotic