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

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.

Antibiotic strategies and clinical outcomes in critically ill patients with pneumonia caused by carbapenem-resistant Acinetobacter baumannii

“…The excess mortality in the tigecycline group is attributed to patients with tigecycline minimum inhibitory concentration (MIC) >2 mg/L. The meta-analysis by Chen et al on infections by A. baumannii found that colistin-based therapy had better microbiological response than non-colistin therapy but no difference in mortality [25]. In addition, colistin combination therapy, compared with colistin monotherapy, had higher clinical response but no difference in mortality.…”

Synergistic combinations of polymyxins

“…In a small prospective trial of 94 patients with carbapenem-resistant A. baumannii , subjects were randomised to receive colistin alone or colistin + fosfomycin and a statistical difference in the infection-related 28-day mortality was not observed (23.1% vs. 16.3%; P = 0.507); however, microbiological cure in the first 72 h (65.7% vs. 78.8%; P = 0.028) and at the end of treatment (84.5% vs. 100%; P = 0.023) did favour combination therapy [56]. A meta-analysis that evaluated the clinical response of patients with MDR A. baumannii treated with colistin alone or in combination found that colistin combinations did not improve clinical response (OR = 1.37, 95% CI 0.86–2.19; P = 0.18), but microbiological response did improve with combination therapy (OR = 2.14, 95% CI 1.48–3.07; P < 0.0001) [57]. Another meta-analysis evaluated all-cause mortality in patients treated with colistin or colistin combinations for carbapenem-resistant Gram-negative bacteria and found no mortality benefit for colistin paired with rifampicin ( P = 0.81), carbapenems ( P = 0.91), tigecycline ( P = 0.77), sulbactam ( P = 0.81) or aminoglycosides ( P = 0.07) [58].…”

New Treatment Options against Carbapenem-Resistant Acinetobacter baumannii Infections

“…Various combinations of these drugs have been used for the treatment of CRAB infections; yet, combination therapies were not found to be superior over monotherapies in preventing resistance and improving clinical outcomes, even though the combination therapies may be better at microbiologic eradication (29)(30)(31)(32).…”