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Safety and efficacy of colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection: a systematic review and meta-analysis / 中华传染病杂志
Chinese Journal of Infectious Diseases ; (12): 414-419, 2019.
Article in Chinese | WPRIM | ID: wpr-754670
ABSTRACT
Objective To study the safety and efficacy of colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection.Methods CNKI, Wanfang database , PubMed, Embase and Cochrane library were systematically searched.Randomized controlled trials about colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection were enrolled.The Cochrane Reviewers′Handbook 5.2 was employed to evaluate the quality of the enrolled studies. The primary outcome was all-cause mortality.The secondary outcomes included infection-related mortality, clinical response, bacterial clearance, nephrotoxicity and hepatotoxicity.Meta-analysis was conducted by RevMan 5.3 software.Results Seven articles containing 859 patients were finally included.There were no significantly statistical differences in all-cause mortality rate (relative risk [RR]=1.07, 95%CI0.93-1.24, P>0.05), infection-related mortality rate (RR=1.35, 95%CI0.98-1.87, P>0.05), bacterial clearance rate (RR=0.85, 95%CI0.71-1.02, P=0.08), hepatotoxicity development rate (RR=0.68, 95%CI0.41-1.13, P=0.14), and nephrotoxicity development rate (RR=1.01, 95%CI0.85-1.22, P>0.05) between colistin monotherapy and combination therapy.The clinical response rate was higher in combination therapy than that in colistin monotherapy ( RR =0.81, 95%CI0.66 -0.98, P =0.03).In the subgroup analysis, no statistical differences were found in all-cause mortality rate between colistin monotherapy and combination therapy for carbapenem-resistant Acinetobacter baumannii infection (RR=1.00, 95%CI0.86-1.12, P>0.05). The dosage of colistin with or without loading dose was not associated with the treatment response .Conclusions Although colistin-based combination therapy has a better clinical response against carbapenem -resistant bacteria infection, especially for Acinetobacter baumannii infection, the mortality rate dose not decline compared to colistin monotherapy.Large-scale randomized controlled trials are needed to evaluate the effect in the future.

Full text: Available Index: WPRIM (Western Pacific) Type of study: Controlled clinical trial / Etiology study / Systematic reviews Language: Chinese Journal: Chinese Journal of Infectious Diseases Year: 2019 Type: Article

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Full text: Available Index: WPRIM (Western Pacific) Type of study: Controlled clinical trial / Etiology study / Systematic reviews Language: Chinese Journal: Chinese Journal of Infectious Diseases Year: 2019 Type: Article