Cefiderocol either in monotherapy or combination versus best available therapy in the treatment of carbapenem-resistant Acinetobacter baumannii infections : A systematic review and meta-analysis
Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved..
BACKGROUND: The best treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still a matter of debate.
OBJECTIVES: To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT).
DATA SOURCES: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023.
STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT.
PARTICIPANTS: Patients with infections due to CRAB.
INTERVENTIONS: Cefiderocol in monotherapy or in combination with other potentially active agents or BAT.
ASSESSMENT OF RISK OF BIAS: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies.
METHODS OF DATA SYNTHESIS: We conducted a meta-analysis pooling risk ratios (RRs) through random effect models.
RESULTS: We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38-47%), the rate of microbiological failure 48% (95% CI 31-65%), the clinical failure rate 43% (95% CI 32-55%), and the rate of ADRs was 3% (95% CI 1-6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43-0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57-0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09-0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate.
CONCLUSIONS: Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:88 |
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| Enthalten in: |
The Journal of infection - 88(2024), 3 vom: 15. März, Seite 106113 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Onorato, Lorenzo [VerfasserIn] |
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| Links: |
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| Themen: |
Acinetobacter |
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| Anmerkungen: |
Date Completed 19.03.2024 Date Revised 19.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jinf.2024.01.012 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368208141 |
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| 245 | 1 | 0 | |a Cefiderocol either in monotherapy or combination versus best available therapy in the treatment of carbapenem-resistant Acinetobacter baumannii infections |b A systematic review and meta-analysis |
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| 500 | |a Date Completed 19.03.2024 | ||
| 500 | |a Date Revised 19.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a BACKGROUND: The best treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still a matter of debate | ||
| 520 | |a OBJECTIVES: To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT) | ||
| 520 | |a DATA SOURCES: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023 | ||
| 520 | |a STUDY ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT | ||
| 520 | |a PARTICIPANTS: Patients with infections due to CRAB | ||
| 520 | |a INTERVENTIONS: Cefiderocol in monotherapy or in combination with other potentially active agents or BAT | ||
| 520 | |a ASSESSMENT OF RISK OF BIAS: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies | ||
| 520 | |a METHODS OF DATA SYNTHESIS: We conducted a meta-analysis pooling risk ratios (RRs) through random effect models | ||
| 520 | |a RESULTS: We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38-47%), the rate of microbiological failure 48% (95% CI 31-65%), the clinical failure rate 43% (95% CI 32-55%), and the rate of ADRs was 3% (95% CI 1-6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43-0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57-0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09-0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate | ||
| 520 | |a CONCLUSIONS: Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
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