Meta-analysis of colistin for the treatment of Acinetobacter baumannii infection

Zhijin Chen, Yu Chen, Yaogao Fang, Xiaotian Wang, Yanqing Chen, Qingsong Qi, Fang Huang, Xungang Xiao, Zhijin Chen, Yu Chen, Yaogao Fang, Xiaotian Wang, Yanqing Chen, Qingsong Qi, Fang Huang, Xungang Xiao

Abstract

Multidrug resistant among Acinetobacter baumannii infection is associated with a high mortality rate and limits the therapeutic options. The aim of this study was to assess the safety and efficacy of colistin monotherapy vs. other single antibiotic therapy AND colistin-based combination therapy (with other antibiotics) vs. colistin alone for the treatment of Acinetobacter baumannii infection. Online electronic database were searched for studies evaluating colistin with or without other antibiotics in treatment of patients with drug-resistant Acinetobacter baumannii infection. Totally, twelve studies met the inclusion criteria. For colistin-based combination therapy, six articles including 668 patients were included. Our results showed that the overall clinical response did not differ significantly between colistin-based combination therapy and monotherapy (OR = 1.37, 95% CI = 0.86-2.19, P = 0.18). This insignificance was also detected in ICU mortality, length of stay and nephrotoxicity (P > 0.05). However, the colistin-based combination therapy was shown increasing the microbiological response (OR = 2.14, 95% CI = 1.48-3.07, P < 0.0001). For colistin monotherapy, six studies involving 491 patients were analyzed. The results were in concordance with the findings of the colistin-based combination therapy group. Our results suggest that colistin may be a promising therapy as safe and efficacious as standard antibiotics for the treatment of drug-resistant Acinetobacter baumannii infection.

Figures

Figure 1. Flow chart demonstrating studies that…
Figure 1. Flow chart demonstrating studies that were processed for inclusion in the447 meta-analysis.
Figure 2. Clinical response of colistin monotherapy…
Figure 2. Clinical response of colistin monotherapy compared with control antibiotics.
Figure 3. Forest plot for microbiological response…
Figure 3. Forest plot for microbiological response between colistin group and control troup.
Figure 4. Forest plot for risk ratios…
Figure 4. Forest plot for risk ratios in terms of mortality of colistin compared with control antibiotics.
Figure 5. Risk of nephrotoxicity with colistin…
Figure 5. Risk of nephrotoxicity with colistin compared with control antibiotics.
Figure 6. Clinical response with colistin combination…
Figure 6. Clinical response with colistin combination therapy compared with monotherapy.
Figure 7. Forest plot for microbiological response…
Figure 7. Forest plot for microbiological response between colistin combination and monotherapy groups.
Figure 8. Risk ratios of mortality between…
Figure 8. Risk ratios of mortality between colistin combination and alone groups.
Figure 9. Funnel plot analysis on the…
Figure 9. Funnel plot analysis on the detection of publication bias in the meta-analysis.

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