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Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: a systematic review and network meta-analysis.
- Source :
-
The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2018 Jan 01; Vol. 73 (1), pp. 22-32. - Publication Year :
- 2018
-
Abstract
- Objectives: To comprehensively compare and rank the efficacy and safety of available treatment options for patients with MDR and XDR Acinetobacter baumannii (AB) infection.<br />Methods: We searched PubMed, Embase and the Cochrane register of trials systematically for studies that examined treatment options for patients with MDR- and XDR-AB infections until April 2016. Network meta-analysis (NMA) was performed to estimate the risk ratio (RR) and 95% CI from both direct and indirect evidence. Primary outcomes were clinical cure and microbiological cure. Secondary outcomes were all-cause mortality and nephrotoxic and non-nephrotoxic adverse events.<br />Results: A total of 29 studies with 2529 patients (median age 60 years; 65% male; median APACHE II score 19.0) were included. Although there were no statistically significant differences between treatment options, triple therapy with colistin, sulbactam and tigecycline had the highest clinical cure rate. Colistin in combination with sulbactam was associated with a significantly higher microbiological cure rate compared with colistin in combination with tigecycline (RR 1.23; 95% CI 1.03-1.47) and colistin monotherapy (RR 1.21; 95% CI 1.06-1.38). No significant differences in all-cause mortality were noted between treatment options. Tigecycline-based therapy also appeared less effective for achieving a microbiological cure and is not appropriate for treating bloodstream MDR- and XDR-AB infections.<br />Conclusions: Combination therapy of colistin with sulbactam demonstrates superiority in terms of microbiological cure with a safety profile similar to that of colistin monotherapy. Thus, our findings support the use of this combination as a treatment for MDR- and XDR-AB infections.<br /> (© The Author 2017. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)
- Subjects :
- Acinetobacter Infections microbiology
Colistin adverse effects
Drug Resistance, Multiple, Bacterial
Drug Therapy, Combination
Female
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Minocycline adverse effects
Minocycline therapeutic use
Pneumonia, Ventilator-Associated drug therapy
Pneumonia, Ventilator-Associated microbiology
Sulbactam adverse effects
Tigecycline
Treatment Outcome
Acinetobacter Infections drug therapy
Acinetobacter baumannii drug effects
Anti-Bacterial Agents therapeutic use
Colistin therapeutic use
Minocycline analogs & derivatives
Sulbactam therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1460-2091
- Volume :
- 73
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of antimicrobial chemotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 29069421
- Full Text :
- https://doi.org/10.1093/jac/dkx368