Monotherapy vs combination therapy in patients with Klebsiella pneumoniae bloodstream infection : A systematic review and meta-analysis
Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved..
OBJECTIVE: To determine whether mortality is lower in patients with Klebsiella pneumoniae bloodstream infection (BSI) who receive combination antimicrobial therapy than in those who receive monotherapy.
METHODS: Two authors independently searched for relevant articles in the PubMed, Embase, Web of Science, and Cochrane Library databases through to August 10, 2023. Risk of bias was evaluated using the ROBINS-I tool. Possible sources of heterogeneity were evaluated by meta-regression using a mixed-effects model.
RESULTS: Among 8044 articles screened, there were 23 studies (3443 patients) that were eligible for meta-analysis. Meta-regression analysis identified the proportion of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI to be a potential source of heterogeneity. Subgroup analysis showed that mortality on monotherapy was significantly higher when the proportion of patients with CRKP BSI was ≥50% (OR 1.75, 95% CI 1.33-2.30) and significantly lower when this proportion was <50% (OR 0.55, 95% CI 0.24-1.24). Overall mortality was significantly higher on tigecycline monotherapy (OR 2.86, 95% CI 1.46-5.59) than on combination therapy containing both these agents. There was a trend in favor of colistin/polymyxin B-containing combination therapy (OR 1.37, 95% CI 0.83-2.28).
CONCLUSIONS: Combination antimicrobial therapy can lower mortality in patients with CRKP but may not show a survival advantage over monotherapy when the proportion of patients with CRKP BSI is <50%. High-quality prospective observational studies are needed because of the high risk of bias and limited data in the studies performed to date.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
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| Enthalten in: |
Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy - 30(2024), 5 vom: 10. März, Seite 372-378 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Li, Dan [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 25.03.2024 Date Revised 25.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jiac.2024.02.007 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368591859 |
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| 100 | 1 | |a Li, Dan |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Monotherapy vs combination therapy in patients with Klebsiella pneumoniae bloodstream infection |b A systematic review and meta-analysis |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2024 Japanese Society of Chemotherapy, Japanese Association for Infectious Diseases, and Japanese Society for Infection Prevention and Control. Published by Elsevier Ltd. All rights reserved. | ||
| 520 | |a OBJECTIVE: To determine whether mortality is lower in patients with Klebsiella pneumoniae bloodstream infection (BSI) who receive combination antimicrobial therapy than in those who receive monotherapy | ||
| 520 | |a METHODS: Two authors independently searched for relevant articles in the PubMed, Embase, Web of Science, and Cochrane Library databases through to August 10, 2023. Risk of bias was evaluated using the ROBINS-I tool. Possible sources of heterogeneity were evaluated by meta-regression using a mixed-effects model | ||
| 520 | |a RESULTS: Among 8044 articles screened, there were 23 studies (3443 patients) that were eligible for meta-analysis. Meta-regression analysis identified the proportion of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) BSI to be a potential source of heterogeneity. Subgroup analysis showed that mortality on monotherapy was significantly higher when the proportion of patients with CRKP BSI was ≥50% (OR 1.75, 95% CI 1.33-2.30) and significantly lower when this proportion was <50% (OR 0.55, 95% CI 0.24-1.24). Overall mortality was significantly higher on tigecycline monotherapy (OR 2.86, 95% CI 1.46-5.59) than on combination therapy containing both these agents. There was a trend in favor of colistin/polymyxin B-containing combination therapy (OR 1.37, 95% CI 0.83-2.28) | ||
| 520 | |a CONCLUSIONS: Combination antimicrobial therapy can lower mortality in patients with CRKP but may not show a survival advantage over monotherapy when the proportion of patients with CRKP BSI is <50%. High-quality prospective observational studies are needed because of the high risk of bias and limited data in the studies performed to date | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a Bacteremia | |
| 650 | 4 | |a Combination therapy | |
| 650 | 4 | |a Klebsiella pneumoniae | |
| 650 | 4 | |a Monotherapy | |
| 650 | 4 | |a Mortality | |
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| 700 | 1 | |a Rao, Huayun |e verfasserin |4 aut | |
| 700 | 1 | |a Xu, Yi |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Min |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jie |e verfasserin |4 aut | |
| 700 | 1 | |a Luo, Jianrong |e verfasserin |4 aut | |
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