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

Zhijin Chen,Xungang Xiao,Xiaotian Wang,Yu Chen,Qingsong Qi,Yaogao Fang,Fang Huang,Yanqing Chen

doi:10.1038/srep17091

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.

Highlights

IntroductionColistin has increasingly been used as salvage therapy, either alone or in combination with other antibiotics, for the treatment of severe infections in critically ill patients[9]
A. baumannii has emerged as a major cause of nosocomial infections
Due to the shortfall of effective antibiotic development for multidrug resistant A. baumannii, colistin is re-investigated in treating the widespread drug-resistant bacteria and has found renewed interest[25]

Summary

Introduction

Colistin has increasingly been used as salvage therapy, either alone or in combination with other antibiotics, for the treatment of severe infections in critically ill patients[9]. It has been recommended in American Thoracic Society Guidelines as a therapeutic option for the treatment of VAP (Ventilator-associated pneumonia) caused by drug-resistant gram-negative organisms[10]. Colistin heteroresistance and colistin resistance have been described in A. baumannii. We conducted this meta-analysis to systematically evaluate the safety and efficacy of colistin for the treatment of A. baumannii infection

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