Cheng I-Ling, Chen Yu-Hung, Lai Chih-Cheng, Tang Hung-Jen
Department of Pharmacy, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
Department of Intensive Care Medicine Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan.
J Clin Med. 2018 Aug 10;7(8):208. doi: 10.3390/jcm7080208.
This meta-analysis aims to compare intravenous colistin monotherapy and colistin-based combination therapy against carbapenem-resistant gram-negative bacteria (GNB) infections. PubMed, Embase, and Cochrane databases were searched up to July 2018. Only randomized controlled trials (RCTs) evaluating colistin alone and colistin-based combination therapy in the treatment of carbapenem-resistant GNB infections were included. The primary outcome was all-cause mortality. Five RCTs including 791 patients were included. Overall, colistin monotherapy was associated with a risk ratio (RR) of 1.03 (95% confidence interval (CI), 0.89⁻1.20, I² = 0%) for all-cause mortality compared with colistin-based combination therapy. The non-significant difference was also detected in infection-related mortality (RR, 1.23, 95% CI, 0.91⁻1.67, I² = 0%) and microbiologic response (RR, 0.86, 95% CI, 0.72⁻1.04, I² = 62%). In addition, no significant difference was observed in the subgroup analysis-high or low dose, with or without a loading dose, carbapenem-resistant infections, and in combination with rifampicin. Finally, colistin monotherapy was not associated with lower nephrotoxicity than colistin combination therapy (RR, 0.98; 95% CI, 0.84⁻1.21, I² = 0%). Based on the analysis of the five RCTs, no differences were found between colistin monotherapy and colistin-based combination therapy against carbapenem-resistant GNB infections, especially for infections.
本荟萃分析旨在比较静脉注射多黏菌素单药治疗与基于多黏菌素的联合治疗对碳青霉烯类耐药革兰阴性菌（GNB）感染的疗效。检索了截至2018年7月的PubMed、Embase和Cochrane数据库。仅纳入评估多黏菌素单药治疗和基于多黏菌素的联合治疗对碳青霉烯类耐药GNB感染疗效的随机对照试验（RCT）。主要结局为全因死亡率。纳入了5项RCT，共791例患者。总体而言，与基于多黏菌素的联合治疗相比，多黏菌素单药治疗的全因死亡率风险比（RR）为1.03（95%置信区间[CI]，0.89⁻1.20，I² = 0%）。在感染相关死亡率（RR，1.23，95% CI，0.91⁻1.67，I² = 0%）和微生物学反应（RR，0.86，95% CI，0.72⁻1.04，I² = 62%）方面也未检测到显著差异。此外，在亚组分析中，高剂量或低剂量、有无负荷剂量、碳青霉烯类耐药感染以及与利福平联合使用时，均未观察到显著差异。最后，多黏菌素单药治疗与多黏菌素联合治疗相比，肾毒性并未降低（RR，0.98；95% CI，0.84⁻1.21，I² = 0%）。基于对这5项RCT的分析，多黏菌素单药治疗与基于多黏菌素的联合治疗在治疗碳青霉烯类耐药GNB感染方面没有差异，尤其是在感染方面。
