OBJECTIVE: To systematically evaluate the efficacy and safety of ceftazidime and avibactam in the treatment of severe Gram-negative bacterial infections. METHODS: CNKI

Wanfang database

PubMed

the Cochrane Library

EMBase and ClinicalTrials. gov database were retrieved to collect the randomized controlled trial of ceftazidime and avibactam in the treatment of severe Gram-negative bacterial infections（ the study group was treated with ceftazidime and avibactam

and complex intraperitoneal infections could be combined with metronidazole; the control group received conventional treatment

such as meropenem

imipenem and cilastatin

cefepime

dorippenem

colistin and tigecycline） according to the inclusion criteria and exclusion criteria. Meta-analysis was performed by using Review Manager 5. 3. RESULTS: Totally 10 literature were collected

including 4 294 patients. Meta-analysis results showed that the clinical cure rate（ RR = 0. 99

95% CI = 0. 96-1. 02

P = 0. 36）

microbial eradication rate（ RR = 1. 06

95% CI =0. 96-1. 17

P = 0. 26）

incidence of adverse drug reactions（ RR = 1. 03

95% CI = 0. 97-1. 10

P = 0. 31）

the incidence of severe adverse drug reactions（ RR = 1. 21

95% CI = 0. 98-1. 49

P = 0. 08） and the mortality rate（ RR =1. 31

95% CI = 0. 90-1. 91

P = 0. 16） were not significantly different from the conventional treatment. Subgroup analysis was performed according to the type of infection

pathogen

renal function status

acute physiology and chronic health evaluation score. In each subgroup

there was no statistically significant difference in the clinical cure rate between ceftazidime and avibactam and conventional treatment（ P > 0. 05）. In the subgroup of complicated urinary tract infections

the microbial eradication rate of ceftazidime and avibactam was significantly better than the conventional treatment（ RR = 1. 14

95% CI = 1. 06-1. 22

P < 0. 01）. In the enterobacter subgroup

the microbial eradication rate of ceftazidime and avibactam was significantly higher than that of the conventional treatment（ RR =1. 11

95% CI = 1. 02-1. 20

P = 0. 01）

especially for Escherichia coli（ RR = 1. 12

95% CI = 1. 04-1. 20

P < 0. 01） and Klebsiella pneumoniae（ RR = 1. 20

95% CI = 1. 03-1. 39

P = 0. 02）. In the remaining subgroups

there was no statistically significant difference in the microbial eradication rate between ceftazidime and avibactam and the conventional treatment（ P > 0. 05）. CONCLUSIONS: Compared with the conventional treatment

the efficacy and safety of ceftazidime and avibactamin the treatment of severe Gram-negative bacterial infections are significant

but which still needs to be verified by large-scale

multi-center randomized controlled trials.