The Journal of hospital infection · 2025
Colistin monotherapy versus colistin combination therapy in the treatment of patients with multidrug-resistant and extensively drug-resistant Acinetobacter baumannii infections: a meta-analysis.
СтатьяМетаанализСистематический обзорСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Falagas M E, Kontogiannis D S, Sargianou M, Bousi S E, Ntourakis D
Аннотация
BACKGROUND: Acinetobacter baumannii infections are a serious healthcare problem worldwide.
AIM: To compare colistin monotherapy with colistin combination therapy for patients with multidrug-resistant (MDR) and extensively drug-resistant (XDR) A. baumannii infection.
METHODS: In this systematic review and meta-analysis, five resources (Cochrane Library, Google Scholar, Web of Science, Scopus, PubMed), and two registries (Clinicaltrials.gov, ICTRP) were used.
FINDINGS: In total, 22 articles were included in the analysis (nine randomized controlled trials (RCTs) and 13 observational) that included 1271 patients treated with colistin monotherapy and 1782 with various combinations of colistin; with carbapenem (N = 909), sulbactam (N = 162), rifampicin (N = 145), tigecycline (N = 111), or various agents (N = 455). Mortality was high in all studied groups: 5-90%, 20-88%, and 21-87%, in the colistin-carbapenem combination, colistin-sulbactam combination, and colistin monotherapy, respectively. Mortality was not statistically significantly different in three RCTs with colistin monotherapy versus colistin-carbapenem combination therapy (odds ratio: 0.65; 95% confidence interval: 0.28-1.52; P = 0.32) and four observational studies with colistin monotherapy versus colistin-sulbactam combination (1.48; 0.85-2.56; P = 0.16).
CONCLUSION: According to the most comprehensive systematic review and meta-analysis yet performed, mortality is high in patients with MDR and XDR A. baumannii infections treated with colistin monotherapy and colistin combination regimens, with no statistically significant differences between them.
AIM: To compare colistin monotherapy with colistin combination therapy for patients with multidrug-resistant (MDR) and extensively drug-resistant (XDR) A. baumannii infection.
METHODS: In this systematic review and meta-analysis, five resources (Cochrane Library, Google Scholar, Web of Science, Scopus, PubMed), and two registries (Clinicaltrials.gov, ICTRP) were used.
FINDINGS: In total, 22 articles were included in the analysis (nine randomized controlled trials (RCTs) and 13 observational) that included 1271 patients treated with colistin monotherapy and 1782 with various combinations of colistin; with carbapenem (N = 909), sulbactam (N = 162), rifampicin (N = 145), tigecycline (N = 111), or various agents (N = 455). Mortality was high in all studied groups: 5-90%, 20-88%, and 21-87%, in the colistin-carbapenem combination, colistin-sulbactam combination, and colistin monotherapy, respectively. Mortality was not statistically significantly different in three RCTs with colistin monotherapy versus colistin-carbapenem combination therapy (odds ratio: 0.65; 95% confidence interval: 0.28-1.52; P = 0.32) and four observational studies with colistin monotherapy versus colistin-sulbactam combination (1.48; 0.85-2.56; P = 0.16).
CONCLUSION: According to the most comprehensive systematic review and meta-analysis yet performed, mortality is high in patients with MDR and XDR A. baumannii infections treated with colistin monotherapy and colistin combination regimens, with no statistically significant differences between them.