Systematic review and meta-analysis of colistin plus meropenem therapy for the treatment of nosocomial pneumonia
-
Hazhir Moradi
,
Zahra Sadat Sajadi-Javan
,
Sarah Mousavi
,
Soodabeh Rostami
,
Bita Moradi Khaniabadi
Abstract
Background and Objectives: 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.
Materials and Methods: 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.
Results: 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.
Conclusion: 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.
2. Zilberberg MD, Shorr AF, Micek ST, Vazquez-Guillamet C, Kollef MH. Multi-drug resistance, inappropriate initial antibiotic therapy and mortality in Gram-negative severe sepsis and septic shock: a retrospective cohort study. Crit Care 2014; 18: 596.
3. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63(5): e61-e111.
4. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268-281.
5. Cheng I-L, Chen Y-H, Lai C-C, Tang H-J. Intravenous colistin monotherapy versus combination therapy against carbapenem-resistant gram-negative bacteria infections: meta-analysis of randomized controlled trials. J Clin Med 2018; 7: 208.
6. Kaye KS, Marchaim D, Thamlikitkul V, Carmeli Y, Chiu C-H, Daikos G, et al. Colistin monotherapy versus combination therapy for carbapenem-resistant organisms. NEJM Evid 2022; 2: 10.1056/evidoa2200131.
7. Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. A novel algorithm to analyze epidemiology and outcomes of carbapenem resistance among patients with hospital-acquired and ventilator-associated pneumonia: a retrospective cohort study. Chest 2019; 155: 1119-1130.
8. Van Duin D, Lok JJ, Earley M, Cober E, Richter SS, Perez F, et al. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Clin Infect Dis 2018; 66: 163-171.
9. Zusman O, Altunin S, Koppel F, Dishon Benattar Y, Gedik H, Paul M. Polymyxin monotherapy or in combination against carbapenem-resistant bacteria: systematic review and meta-analysis. J Antimicrob Chemother 2017; 72: 29-39.
10. Scudeller L, Righi E, Chiamenti M, Bragantini D, Menchinelli G, Cattaneo P, et al. Systematic review and meta-analysis of in vitro efficacy of antibiotic combination therapy against carbapenem-resistant Gram-negative bacilli. Int J Antimicrob Agents 2021; 57: 106344.
11. Hou S-Y, Wu D, Feng X-H. Polymyxin monotherapy versus polymyxin-based combination therapy against carbapenem-resistant Klebsiella pneumoniae: A systematic review and meta-analysis. J Glob Antimicrob Resist 2020; 23: 197-202.
12. Cheah S-E, Wang J, Nguyen VTT, Turnidge JD, Li J, Nation RL. New pharmacokinetic/pharmacodynamic studies of systemically administered colistin against Pseudomonas aeruginosa and Acinetobacter baumannii in mouse thigh and lung infection models: smaller response in lung infection. J Antimicrob Chemother 2015; 70: 3291-3297.
13. Nation RL, Garonzik SM, Thamlikitkul V, Giamarellos-Bourboulis EJ, Forrest A, Paterson DL, et al. Dosing guidance for intravenous colistin in critically ill patients. Clin Infect Dis 2017; 64: 565-571.
14. Zusman O, Avni T, Leibovici L, Adler A, Friberg L, Stergiopoulou T, et al. Systematic review and meta-analysis of in vitro synergy of polymyxins and carbapenems. Antimicrob Agents Chemother 2013; 57: 5104-5111.
15. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8: 336-341.
16. Abdelsalam MFA, Abdalla MS, El-Abhar HSE-D. Prospective, comparative clinical study between high-dose colistin monotherapy and colistin–meropenem combination therapy for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia caused by multidrug-resistant Klebsiella pneumoniae. J Glob Antimicrob Resist 2018; 15: 127-135.
17. Momenzadeh M, Soltani R, Shafiee F, Hakamifard A, Pourahmad M, Abbasi S. The effectiveness of colistin/levofloxacin compared to colistin/meropenem in the treatment of ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii: a randomized controlled clinical trial. Res Pharm Sci 2023; 18: 39-48.
18. Khalili H, Shojaei L, Mohammadi M, Beigmohammadi M-T, Abdollahi A, Doomanlou M. Meropenem/colistin versus meropenem/ampicillin–sulbactam in the treatment of carbapenem-resistant pneumonia. J Comp Eff Res 2018; 7: 901-911.
19. Paul M, Daikos GL, Durante-Mangoni E, Yahav D, Carmeli Y, Benattar YD, et al. Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial. Lancet Infect Dis 2018; 18: 391-400.
20. Nutman A, Lellouche J, Temkin E, Daikos G, Skiada A, Durante-Mangoni E, et al. Colistin plus meropenem for carbapenem-resistant Gram-negative infections: In vitro synergism is not associated with better clinical outcomes. Clin Microbiol Infect 2020; 26: 1185-1191.
21. Liu C-P, Shih S-C, Wang N-Y, Wu AY, Sun F-J, Chow S-F, et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect 2016; 49: 934-940.
22. Almomani BA, McCullough A, Gharaibeh R, Samrah S, Mahasneh F. Incidence and predictors of 14-day mortality in multidrug-resistant Acinetobacter baumannii in ventilator-associated pneumonia. J Infect Dev Ctries 2015; 9: 1323-1330.
23. Zheng N, Zhu D, Han Y. Procalcitonin and C-reactive protein perform better than the neutrophil/lymphocyte count ratio in evaluating hospital acquired pneumonia. BMC Pulm Med 2020; 20: 166.
| Files | ||
| Issue | Vol 16 No 6 (2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i6.17244 | |
| Keywords | ||
| Meropenem; Colistin; Multiple drug-resistance; Nosocomial infection; Pneumonia | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
