Reappraisal of Colistin-Based Regimens Against Multidrug-Resistant Gram-Negative Bacterial Infections: Meta-Analysis and Trial Sequential Analysis

Chang-Hua Chen ； Yu-Min Chen ； Yu-Jun Chang

《The Changhua Journal of Medicine》 17卷4期 (2019/12) Pp. 186-201

https://doi.org/10.6501/CJM.201912_17(4).0006

摘要

The incidence of multidrug-resistant (MDR) gram-negative bacteria (GNB) infections has increased, but whether or not a colistin-based combination regimen is more effective than monotherapy is not conclusive. We performed a comprehensive meta-analysis and trial sequential analysis to provide evidence of the efficacy of colistin-based combination therapy for the treatment of MDR GNB infections. The meta-analysis showed that the overall odds ratios when comparing the two groups were 0.94 (95% confidence interval [CI]: 0.75-1.18) for the infection-related mortality rate; 1.01 (95% CI: 0.71-1.40) for the microbiological response; 1.36 (95% CI: 0.92-2.00) for the clinical response; and 1.01 (95% CI: 0.72-1.40) for adverse drug reactions (ADRs). In trial sequential analysis, the required information sizes were not reached for the four outcomes. The results of the meta-analysis and trial sequential analysis did not favor colistin-based combination therapy in terms of lower rates of infection-related mortality and ADRs, nor stronger microbiological or clinical responses, over monotherapy.

關鍵字

colistin-based regimen ； combination therapy ； gram-negative bacteria ； monotherapy ； multidrug-resistant