Moradi Hazhir, Sajadi-Javan Zahra Sadat, Mousavi Sarah, Rostami Soodabeh, Moradi Khaniabadi Bita
Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.
Iran J Microbiol. 2024 Dec;16(6):722-731. doi: 10.18502/ijm.v16i6.17244.
Nosocomial pneumonia caused by multidrug-resistant gram-negative bacteria presents a significant challenge for healthcare systems, as there are limited effective treatments available. This systematic review and meta-analysis aim to investigate the outcomes of colistin plus meropenem combination therapy on nosocomial pneumonia.
An exhaustive search of PubMed, Scopus, Web of Science (WOS), and Embase databases was conducted, resulting in the extraction of 5 studies for qualitative assessment and meta-analysis. The study sample included 991 patients admitted with nosocomial pneumonia. The outcomes evaluated were clinical improvement, microbiological response, mortality, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Charlson Comorbidity Index (CCI), Clinical Pulmonary Infection Score (CPIS), C-reactive protein (CRP) levels, procalcitonin (PCT) levels, and intensive care unit (ICU) duration.
The results demonstrated that colistin plus meropenem combination therapy significantly improved clinical outcomes (OR = 1.37, 95% CI = 1.04-1.81, p = 0.027), reduced SOFA scores (OR = -0.28, 95% CI = -0.44 to -0.11, p = 0.001), and increased CCI scores (OR = 0.16, 95% CI = 0.02-0.29, p = 0.021) compared to other medications. However, other evaluated parameters did not show significant differences.
This meta-analysis indicates that colistin-meropenem combination therapy is superior to other colistin-based treatments for nosocomial pneumonia in terms of clinical improvement, SOFA score reduction, and CCI score increase. Nevertheless, other variables assessed did not exhibit remarkable differences between the treatment regimens.
耐多药革兰氏阴性菌引起的医院获得性肺炎对医疗系统构成重大挑战，因为有效的治疗方法有限。本系统评价和荟萃分析旨在研究黏菌素联合美罗培南治疗医院获得性肺炎的疗效。
对PubMed、Scopus、科学网（WOS）和Embase数据库进行了全面检索，提取了5项研究进行定性评估和荟萃分析。研究样本包括991例医院获得性肺炎患者。评估的结果包括临床改善情况、微生物学反应、死亡率、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评估（APACHE II）评分、查尔森合并症指数（CCI）、临床肺部感染评分（CPIS）、C反应蛋白（CRP）水平、降钙素原（PCT）水平和重症监护病房（ICU）住院时间。
结果表明，与其他药物相比，黏菌素联合美罗培南治疗显著改善了临床结局（OR = 1.37，95%CI = 1.04 - 1.81，p = 0.027），降低了SOFA评分（OR = -0.28，95%CI = -0.44至-0.11，p = 0.001），并提高了CCI评分（OR = 0.16，95%CI = 0.02 - 0.29，p = 0.021）。然而，其他评估参数未显示出显著差异。
本荟萃分析表明，在临床改善、降低SOFA评分和提高CCI评分方面，黏菌素 - 美罗培南联合治疗优于其他基于黏菌素的医院获得性肺炎治疗方法。然而，各治疗方案之间评估的其他变量未表现出显著差异。
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