Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis
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 studie...
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doaj-b1936db216a74504ae017e16ec0e950d2021-05-21T04:21:01ZengElsevierJournal of Global Antimicrobial Resistance2213-71652020-12-0123197202Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysisSi-Yuan Hou0Dan Wu1Xing-Huo Feng2Intensive Care Unit, The People’s Hospital of Liaoning Province, NO. 33 Wenyi Road, Shenhe District, Shenyang, Liaoning 110016, China; Corresponding authors.Second Department of Rheumatology, Shengjing Hospital of China Medical University, 39 Huaxiang Road, Tiexi District, Shenyang, Liaoning 110022, ChinaIntensive Care Unit, The People’s Hospital of Liaoning Province, NO. 33 Wenyi Road, Shenhe District, Shenyang, Liaoning 110016, China; Corresponding authors.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.http://www.sciencedirect.com/science/article/pii/S2213716520302320PolymyxinMonotherapyCombination therapyCarbapenem-resistant Klebsiella pneumoniae |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Si-Yuan Hou Dan Wu Xing-Huo Feng |
spellingShingle |
Si-Yuan Hou Dan Wu Xing-Huo Feng Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis Journal of Global Antimicrobial Resistance Polymyxin Monotherapy Combination therapy Carbapenem-resistant Klebsiella pneumoniae |
author_facet |
Si-Yuan Hou Dan Wu Xing-Huo Feng |
author_sort |
Si-Yuan Hou |
title |
Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis |
title_short |
Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis |
title_full |
Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis |
title_fullStr |
Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis |
title_full_unstemmed |
Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis |
title_sort |
polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant klebsiella pneumoniae: a systematic review and meta-analysis |
publisher |
Elsevier |
series |
Journal of Global Antimicrobial Resistance |
issn |
2213-7165 |
publishDate |
2020-12-01 |
description |
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. |
topic |
Polymyxin Monotherapy Combination therapy Carbapenem-resistant Klebsiella pneumoniae |
url |
http://www.sciencedirect.com/science/article/pii/S2213716520302320 |
work_keys_str_mv |
AT siyuanhou polymyxinmonotherapyversuspolymyxinbasedcombinationtherapyagainstcarbapenemresistantklebsiellapneumoniaeasystematicreviewandmetaanalysis AT danwu polymyxinmonotherapyversuspolymyxinbasedcombinationtherapyagainstcarbapenemresistantklebsiellapneumoniaeasystematicreviewandmetaanalysis AT xinghuofeng polymyxinmonotherapyversuspolymyxinbasedcombinationtherapyagainstcarbapenemresistantklebsiellapneumoniaeasystematicreviewandmetaanalysis |
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1721432710937837568 |