H. Meng, Ailing Zhang, Jingli Lu, Xiaoli Guo, Xiaojian Zhang
{"title":"粘菌素单一疗法与联合疗法治疗碳青霉烯耐药革兰氏阴性菌感染的安全性和有效性:系统综述和荟萃分析","authors":"H. Meng, Ailing Zhang, Jingli Lu, Xiaoli Guo, Xiaojian Zhang","doi":"10.3760/CMA.J.ISSN.1000-6680.2019.07.006","DOIUrl":null,"url":null,"abstract":"Objective \nTo study the safety and efficacy of colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection. \n \n \nMethods \nCNKI, 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. \n \n \nResults \nSeven articles containing 859 patients were finally included.There were no significantly statistical differences in all-cause mortality rate (relative risk [RR]=1.07, 95%CI: 0.93-1.24, P>0.05), infection-related mortality rate (RR=1.35, 95%CI: 0.98-1.87, P>0.05), bacterial clearance rate (RR=0.85, 95%CI: 0.71-1.02, P=0.08), hepatotoxicity development rate (RR=0.68, 95%CI: 0.41-1.13, P=0.14), and nephrotoxicity development rate (RR=1.01, 95%CI: 0.85-1.22, 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%CI: 0.66-0.98, 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%CI: 0.86-1.12, P>0.05). The dosage of colistin with or without loading dose was not associated with the treatment response. \n \n \nConclusions \nAlthough 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. \n \n \nKey words: \nColistin; Meta-analysis; Carbapenem-resistant gram-negative bacteria; Systematic review","PeriodicalId":10127,"journal":{"name":"中华传染病杂志","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2019-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Safety and efficacy of colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection: a systematic review and meta-analysis\",\"authors\":\"H. Meng, Ailing Zhang, Jingli Lu, Xiaoli Guo, Xiaojian Zhang\",\"doi\":\"10.3760/CMA.J.ISSN.1000-6680.2019.07.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective \\nTo study the safety and efficacy of colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection. \\n \\n \\nMethods \\nCNKI, 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. \\n \\n \\nResults \\nSeven articles containing 859 patients were finally included.There were no significantly statistical differences in all-cause mortality rate (relative risk [RR]=1.07, 95%CI: 0.93-1.24, P>0.05), infection-related mortality rate (RR=1.35, 95%CI: 0.98-1.87, P>0.05), bacterial clearance rate (RR=0.85, 95%CI: 0.71-1.02, P=0.08), hepatotoxicity development rate (RR=0.68, 95%CI: 0.41-1.13, P=0.14), and nephrotoxicity development rate (RR=1.01, 95%CI: 0.85-1.22, 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%CI: 0.66-0.98, 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%CI: 0.86-1.12, P>0.05). The dosage of colistin with or without loading dose was not associated with the treatment response. \\n \\n \\nConclusions \\nAlthough 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. \\n \\n \\nKey words: \\nColistin; Meta-analysis; Carbapenem-resistant gram-negative bacteria; Systematic review\",\"PeriodicalId\":10127,\"journal\":{\"name\":\"中华传染病杂志\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"中华传染病杂志\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.07.006\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"中华传染病杂志","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3760/CMA.J.ISSN.1000-6680.2019.07.006","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Safety and efficacy of colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infection: a systematic review and meta-analysis
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%CI: 0.93-1.24, P>0.05), infection-related mortality rate (RR=1.35, 95%CI: 0.98-1.87, P>0.05), bacterial clearance rate (RR=0.85, 95%CI: 0.71-1.02, P=0.08), hepatotoxicity development rate (RR=0.68, 95%CI: 0.41-1.13, P=0.14), and nephrotoxicity development rate (RR=1.01, 95%CI: 0.85-1.22, 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%CI: 0.66-0.98, 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%CI: 0.86-1.12, 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.
Key words:
Colistin; Meta-analysis; Carbapenem-resistant gram-negative bacteria; Systematic review