Efficacy and Safety of Colistin versus Tigecycline for Multi-Drug-Resistant and Extensively Drug-Resistant Gram-Negative Pathogens-A Meta-Analysis

被引:7
作者
Abushanab, Dina [1 ]
Nasr, Ziad G. G. [2 ]
Al-Badriyeh, Daoud [2 ]
机构
[1] Hamad Med Corp, Dept Pharm, Doha 3050, Qatar
[2] Qatar Univ, Coll Pharm, QU Hlth, Doha 2713, Qatar
来源
ANTIBIOTICS-BASEL | 2022年 / 11卷 / 11期
关键词
colistin; extensively drug-resistant; infection; multi-drug resistant; tigecycline; ACINETOBACTER-BAUMANNII INFECTIONS; BLOOD-STREAM INFECTIONS; KLEBSIELLA-PNEUMONIAE; COMBINATION THERAPY; CARBAPENEM; MORTALITY; MULTICENTER; MONOTHERAPY; PREDICTORS; PLUS;
D O I
10.3390/antibiotics11111630
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background: We intended to compare the efficacy and safety outcomes of colistin versus tigecycline as monotherapy or combination therapy against multi-drug resistant (MDR) and extensively drug-resistant (XDR) pathogens. Methods: A search was conducted in PubMed, Cochrane CENTRAL, EMBASE, and in the grey literature (i.e., ClinicalTrials.gov and Google Scholar) up to May 2021. Outcomes were clinical response, mortality, infection recurrence, and renal and hepatic toxicity. We pooled odd ratios (OR) using heterogeneity-guided random or fixed models at a statistical significance of p < 0.05. Results: Fourteen observational studies involving 1163 MDR/XDR pathogens, receiving tigecycline versus colistin monotherapy or combination, were included. Base-case analyses revealed insignificant differences in the clinical response, reinfection, and hepatic impairment. The 30-day mortality was significantly relatively reduced with tigecycline monotherapy (OR = 0.35, 95% CI 0.16-0.75, p = 0.007). The colistin monotherapy significantly relatively reduced in-hospital mortality (OR = 2.27, 95%CI 1.24-4.16, p = 0.008). Renal impairment rates were lower with tigecycline monotherapy or in combination, and were lower with monotherapy versus colistin-tigecycline combination. Low-risk of bias and moderate/high evidence quality were associated with all studies. Conclusions: Within the limitations of this study, it can be concluded that there were no statistically significant differences in main efficacy outcomes between colistin and tigecycline monotherapies or combinations against MDR/XDR infections, except for lower rates of 30-day mortality with tigecycline and in-hospital mortality with colistin. Tigecycline was associated with favourable renal toxicity outcomes.
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页数:18
相关论文
共 45 条
[1]   Activity of Eravacycline against Enterobacteriaceae and Acinetobacter baumannii, Including Multidrug-Resistant Isolates, from New York City [J].
Abdallah, Marie ;
Olafisoye, Olawole ;
Cortes, Christopher ;
Urban, Carl ;
Landman, David ;
Quale, John .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2015, 59 (03) :1802-1805
[2]   Efficacy and Safety of Ibuprofen Plus Paracetamol in a Fixed-Dose Combination for Acute Postoperative Pain in Adults: Meta-Analysis and a Trial Sequential Analysis [J].
Abushanab, Dina ;
Al-Badriyeh, Daoud .
CNS DRUGS, 2021, 35 (01) :105-120
[3]   The combined use of tigecycline with high-dose colistin might not be associated with higher survival in critically ill patients with bacteraemia due to carbapenem-resistant Acinetobacter baumannii [J].
Amat, T. ;
Gutierrez-Pizarraya, A. ;
Machuca, I. ;
Gracia-Ahufinger, I. ;
Perez-Nadales, E. ;
Torre-Gimenez, A. ;
Garnacho-Montero, J. ;
Cisneros, J. M. ;
Torre-Cisneros, J. .
CLINICAL MICROBIOLOGY AND INFECTION, 2018, 24 (06) :630-634
[4]  
[Anonymous], 2011, AHRQ Publication
[5]   Is there a future for tigecycline? [J].
Bassetti, Matteo ;
Poulakou, Garyfallia ;
Giamarellou, Helen .
INTENSIVE CARE MEDICINE, 2014, 40 (07) :1039-1045
[6]   Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections [J].
Batirel, A. ;
Balkan, I. I. ;
Karabay, O. ;
Agalar, C. ;
Akalin, S. ;
Alici, O. ;
Alp, E. ;
Altay, F. A. ;
Altin, N. ;
Arslan, F. ;
Aslan, T. ;
Bekiroglu, N. ;
Cesur, S. ;
Celik, A. D. ;
Dogan, M. ;
Durdu, B. ;
Duygu, F. ;
Engin, A. ;
Engin, D. O. ;
Gonen, I. ;
Guclu, E. ;
Guven, T. ;
Hatipoglu, C. A. ;
Hosoglu, S. ;
Karahocagil, M. K. ;
Kilic, A. U. ;
Ormen, B. ;
Ozdemir, D. ;
Ozer, S. ;
Oztoprak, N. ;
Sezak, N. ;
Turhan, V. ;
Turker, N. ;
Yilmaz, H. .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2014, 33 (08) :1311-1322
[7]   Cefiderocol-Based Combination Therapy for "Difficult-to-Treat" Gram-Negative Severe Infections: Real-Life Case Series and Future Perspectives [J].
Bavaro, Davide Fiore ;
Belati, Alessandra ;
Diella, Lucia ;
Stufano, Monica ;
Romanelli, Federica ;
Scalone, Luca ;
Stolfa, Stefania ;
Ronga, Luigi ;
Maurmo, Leonarda ;
Dell'Aera, Maria ;
Mosca, Adriana ;
Dalfino, Lidia ;
Grasso, Salvatore ;
Saracino, Annalisa .
ANTIBIOTICS-BASEL, 2021, 10 (06)
[8]   Meropenem/Vaborbactam Plus Aztreonam as a Possible Treatment Strategy for Bloodstream Infections Caused by Ceftazidime/Avibactam-Resistant Klebsiella pneumoniae: A Retrospective Case Series and Literature Review [J].
Belati, Alessandra ;
Bavaro, Davide Fiore ;
Diella, Lucia ;
De Gennaro, Nicolo ;
Di Gennaro, Francesco ;
Saracino, Annalisa .
ANTIBIOTICS-BASEL, 2022, 11 (03)
[9]   Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa [J].
Bonomo, Robert A. ;
Szabo, Dora .
CLINICAL INFECTIOUS DISEASES, 2006, 43 :S49-S56
[10]   Excess Mortality Associated With Colistin-Tigecycline Compared With Colistin-Carbapenem Combination Therapy for Extensively Drug-Resistant Acinetobacter baumannii Bacteremia: A Multicenter Prospective Observational Study [J].
Cheng, Aristine ;
Chuang, Yu-Chung ;
Sun, Hsin-Yun ;
Sheng, Wang-Huei ;
Yang, Chia-Jui ;
Liao, Chun-Hsing ;
Hsueh, Po-Ren ;
Yang, Jia-Ling ;
Shen, Ni-Jiin ;
Wang, Jann-Tay ;
Hung, Chien-Ching ;
Chen, Yee-Chun ;
Chang, Shan-Chwen .
CRITICAL CARE MEDICINE, 2015, 43 (06) :1194-1204