Abstract
BackgroundMulti-drug resistance among Acinetobacter baumannii increases the need for polymyxins. We conducted a meta-analysis aimed to assess the efficacy and safety of polymyxins for the treatment of Acinetobacter baumannii infection.MethodsWe searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, Chinese Biomedical Literature Database up to November 1, 2013, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies. Randomized controlled trials and cohort studies were considered for inclusion. Data were extracted on clinical response, microbiological response, mortality, length of stay and adverse events.Results12 controlled studies, comparing 677 patients, were included. Although clinical (odds ratio 1.421, 95% confidence interval 0.722–2.797) and microbiological (OR 1.416, 95% CI 0.369–5.425) response rates favored the polymyxins group, these differences were not significant. Treatment with polymyxins vs. controls did not affect hospital mortality (OR 0.506, 95% CI 0.101–2.536), lengths of hospital stay (standard mean difference −0.221, 95% CI 0.899–0.458) or nephrotoxicity (OR 1.192, 95% CI 0.436–3.261). The combination of polymyxins with other antibiotics achieved similar clinical response rates to its monotherapy regimen (OR 0.601, 95% CI 0.320–1.130).ConclusionsOur results suggest that polymyxins may be as safe and as efficacious as standard antibiotics for the treatment of A. baumannii infection. There is no strong evidence that combination regimen of polymyxins is superior to monotherapy regimen.
Highlights
Being a non-fermentative Gram-negative coccobacillus, Acinetobacter baumannii has become an increasingly notorious pathogen of healthcare associated infection in recent years
Selection Criteria Studies were considered eligible for inclusion if they were randomized controlled trials (RCT) or cohort studies with designs comparing the efficacy and safety of polymyxins against other antimicrobial agents for the treatment of A. baumannii infection
Clinical response rates favored the polymyxins group, the difference was not significant
Summary
Being a non-fermentative Gram-negative coccobacillus, Acinetobacter baumannii has become an increasingly notorious pathogen of healthcare associated infection in recent years. According to the data from a USA 7-year national surveillance project that detected 24179 cases with healthcare associated bacteremia, A. baumannii was found to be the 10th most frequent pathogen and crude mortality ranges from 30% to 50% in patients with A. baumannii bacteremia [1]. This pathogen can lead to different types of infections such as respiratory tract infection, bloodstream infection, skin and soft tissue infections, urinary tract infections, and meningitis. Multi-drug resistance among Acinetobacter baumannii increases the need for polymyxins. We conducted a meta-analysis aimed to assess the efficacy and safety of polymyxins for the treatment of Acinetobacter baumannii infection
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