Safety and efficacy of colistin alone or in combination in adults with Acinetobacter baumannii infection: A systematic review and meta-analysis
Safety and efficacy of colistin alone or in combination in adults with Acinetobacter baumannii infection: A systematic review and meta-analysis
复制标题
单独或联合使用粘菌素治疗鲍曼不动杆菌感染成人的安全性和有效性：系统评价和荟萃分析
DOI：
10.1016/j.ijantimicag.2018.10.020
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发表时间：
2019
影响因子：
10.8
通讯作者：
Cai Yun
中科院分区：
文献类型：
--
作者：
Wang Jin;Niu Hui;Wang Rui;Cai Yun
这篇综述全面评估了粘菌素单独或联合治疗成人鲍曼不动杆菌感染的安全性和有效性。从最初到2018年3月，在PubMed、Embase和Cochrane图书馆中搜索评价粘菌素单一疗法与其他抗生素疗法或基于粘菌素的联合疗法治疗OFA的比较的研究。成人感染鲍曼氏杆菌。疗效结果为临床反应和微生物治愈。安全结局为死亡率和肾毒性不良事件。总共确定了4项随机对照试验(RCT)和14项观察性研究，其中7项报告了粘菌素与其他抗生素的对比，12项报告了粘菌素单一疗法与基于粘菌素的联合疗法。粘菌素单一治疗与其他抗生素治疗的总体临床反应、微生物学反应和死亡率没有显著差异。单用粘菌素组肾毒性发生率明显高于单纯粘菌素组(OR = 2.5 0，95%CI 1.0 5~5.98；P= 0.0 4)。粘菌素单独治疗和联合治疗在临床反应和28天死亡率方面没有发现显著差异。但粘菌素联合治疗组的微生物学反应增加(OR = 0.49，95%CI 0.32~0.74；P= 0.0009)，肾毒性发生率降低(OR = 1.66，95%CI 0.99~2.78；P=0.0009)。总而言之，单用粘菌素治疗OFA与其他抗生素一样有效。鲍曼氏杆菌感染，但肾毒性风险较高。与单一治疗相比，基于粘菌素的联合治疗显示出微生物学益处，并且没有更高的肾毒性风险。仍然需要高质量的随机对照试验来证实基于粘菌素的联合治疗的有益作用。
This review comprehensively assessed the safety and efficacy of colistin alone or in combination in adults withAcinetobacter baumanniiinfection. PubMed, Embase and the Cochrane Library were searched from inception to March 2018 for studies evaluating colistin monotherapy compared with other antibiotic therapy or colistin-based combination therapy for the treatment ofA. baumanniiinfection in adults. Efficacy outcomes were clinical response and microbiological cure. Safety outcomes were mortality and nephrotoxic adverse events. A total of 4 randomised controlled trials (RCTs) and 14 observational studies were identified, including 7 reporting colistin versus other antibiotics and 12 reporting colistin monotherapy versus colistin-based combination therapy. Overall clinical response, microbiological response and mortality did not differ significantly between colistin monotherapy versus other antibiotics. However, the incidence of nephrotoxicity was significantly higher in colistin monotherapy (OR = 2.50, 95% CI 1.05–5.98;P= 0.04). No significant differences were detected in clinical response and >28-day mortality between colistin monotherapy and combination therapy. However, colistin-based combination therapy showed an increased microbiological response (OR = 0.49, 95% CI 0.32–0.74;P= 0.0009) and decreased incidence of nephrotoxicity (OR = 1.66, 95% CI 0.99–2.78;P=0.05). In conclusion, colistin alone is as effective as other antibiotics for the treatment ofA. baumanniiinfection but has a higher risk of nephrotoxicity. Colistin-based combination therapy demonstrated a microbiological benefit and no higher risk of nephrotoxicity compared with monotherapy. High-quality RCTs are still needed to confirm the beneficial role of colistin-based combination therapy.