Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis
| Autor: | Dan Wu, Xing-Huo Feng, Si-Yuan Hou |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) Carbapenem medicine.medical_specialty Combination therapy medicine.drug_class Polymyxin 030106 microbiology Immunology Subgroup analysis Tigecycline Microbiology 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Immunology and Allergy Medicine Polymyxins 030212 general & internal medicine business.industry Odds ratio Monotherapy QR1-502 Klebsiella Infections Klebsiella pneumoniae Regimen Carbapenem-Resistant Enterobacteriaceae Carbapenems Meta-analysis Carbapenem-resistant Klebsiella pneumoniae business medicine.drug |
| Zdroj: | Journal of Global Antimicrobial Resistance, Vol 23, Iss, Pp 197-202 (2020) |
| ISSN: | 2213-7165 |
| Popis: | Objectives This meta-analysis was performed to compare polymyxin monotherapy and polymyxin-based combination therapy for carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections. Methods We conducted searches on MEDLINE, Embase and Cochrane Collaborative database for both observational studies and randomised controlled trials (RCTs) comparing polymyxin monotherapy with polymyxin-based combination therapy in patients with CR-KP infection. The primary outcome was mortality. We divided all included studies into several groups according to different combination-combination and different infection types. The odds ratio (OR) and 95% confidence intervals (CI) were calculated for outcome analysis. Results Ten studies with 481 patients were included. Polymyxin monotherapy was associated with higher mortality than polymyxin-based combination therapy in treatment of CR-KP bloodstream infections (BSI) (OR 1.93, 95% CI 1.14–3.27, P = 0.01) and ventilator-associated pneumonia (VAP)/hospital-acquired pneumonia (HAP) (OR 3.82, 95% CI 1.15–12.71, P = 0.03). In subgroup analysis of different combinations, mortality was significantly higher with polymyxin monotherapy compared with combination therapy with tigecycline (OR 1.88, 95% CI 1.05–3.37, P = 0.03), or with cabapenem (OR 3.11, 95% CI 1.25–7.74, P = 0.01), but no differences were found in combinations with aminoglycosides (OR 1.29, 95% CI 0.72–2.29, P = 0.38). Three-drug combination therapy including polymyxin was also associated with significant survival benefit (OR 3.86, 95% CI 1.60–9.32, P = 0.003). Conclusions Polymyxin-based combination therapy provides significant survival benefit in treatment of CR-KP, which appears to be more pronounced when a carbapenem or tigecycline is included in the regimen. |
| Databáze: | OpenAIRE |
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