Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis
Abstract Background Bloodstream infection of Klebsiella pneumoniae (BSI-KP) were associated with increased mortality. Klebsiella pneumoniae was tested to susceptible to colistin by E-test and broth microdilution method in clinical laboratory. This study aimed to assess the efficacy of colistin versu...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12879-024-09024-6 |
| _version_ | 1827328482460303360 |
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| author | Tao Wang Hongcheng Liu Huiqing Huang Yuesong Weng Xiaojun Wang |
| author_facet | Tao Wang Hongcheng Liu Huiqing Huang Yuesong Weng Xiaojun Wang |
| author_sort | Tao Wang |
| collection | DOAJ |
| description | Abstract Background Bloodstream infection of Klebsiella pneumoniae (BSI-KP) were associated with increased mortality. Klebsiella pneumoniae was tested to susceptible to colistin by E-test and broth microdilution method in clinical laboratory. This study aimed to assess the efficacy of colistin versus tigecycline, carbapenem monotherapy and combination in the treatment of BSI-KP. Methods Electronic databases such as PubMed, Web of Science and Embase were searched. The last search was in November 24th, 2022, addressing the colistin, carbapenems and tigecycline monotherapy and combination treatments in patients with BSI-KP. The primary outcomes were 30-day or 28-day mortality. OR where available with 95% CI were pooled in random-effects meta-analysis. Results Following the outlined search strategy, a total of 658 articles were identified from the initial database searching. Six studies, 17 comparisons were included. However, they all were observational design, lacking high-quality randomized controlled trials (RCTs). Moderate or low-quality evidences suggested that colistin monotherapy was associated with an OR = 1.35 (95% CI = 0.62–2.97, P = 0.45, Tau 2 = 0.00, I 2 = 0%) compared with tigecycline monotherapy, OR = 0.81 (95% CI = 0.27–2.45, P = 0.71, Tau 2 = 0.00, I 2 = 0%) compared with carbapenem monotherapy. Compared with combination with tigecycline or carbapenem, Colistin monotherapy resulted in OR of 3.07 (95% CI = 1.34–7.04, P = 0.008, Tau 2 = 0.00, I 2 = 0%) and 0.98 (95%CI = 0.29–3.31, P = 0.98, Tau 2 = 0.00, I 2 = 0% ), respectively. Conclusions Colistin, carbapenem and tigecycline monotherapy showed similar treatment effects in patients who suffered from BSI-KP. Compared with colistin monotherapy, colistin combined tigecycline therapy might play the synergism effects. Trial registration retrospectively registered. |
| first_indexed | 2024-03-07T15:18:32Z |
| format | Article |
| id | doaj.art-ee04e293633a4789a24e09cb1df4c72c |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-07T15:18:32Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-ee04e293633a4789a24e09cb1df4c72c2024-03-05T17:49:44ZengBMCBMC Infectious Diseases1471-23342024-02-012411910.1186/s12879-024-09024-6Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysisTao Wang0Hongcheng Liu1Huiqing Huang2Yuesong Weng3Xiaojun Wang4Center of Clinical Laboratory, The First Affiliated Hospital of Soochow UniversityDepartment of Obstetrics and Gynecology, The First Affiliated Hospital of Soochow UniversityDepartment of Clinical Laboratory, The Lianyungang Oriental HospitalDepartment of Clinical Laboratory, The Affiliated People’s Hospital of Ningbo UniversityDepartment of Clinical Laboratory, Suzhou Wuzhong People’s HospitalAbstract Background Bloodstream infection of Klebsiella pneumoniae (BSI-KP) were associated with increased mortality. Klebsiella pneumoniae was tested to susceptible to colistin by E-test and broth microdilution method in clinical laboratory. This study aimed to assess the efficacy of colistin versus tigecycline, carbapenem monotherapy and combination in the treatment of BSI-KP. Methods Electronic databases such as PubMed, Web of Science and Embase were searched. The last search was in November 24th, 2022, addressing the colistin, carbapenems and tigecycline monotherapy and combination treatments in patients with BSI-KP. The primary outcomes were 30-day or 28-day mortality. OR where available with 95% CI were pooled in random-effects meta-analysis. Results Following the outlined search strategy, a total of 658 articles were identified from the initial database searching. Six studies, 17 comparisons were included. However, they all were observational design, lacking high-quality randomized controlled trials (RCTs). Moderate or low-quality evidences suggested that colistin monotherapy was associated with an OR = 1.35 (95% CI = 0.62–2.97, P = 0.45, Tau 2 = 0.00, I 2 = 0%) compared with tigecycline monotherapy, OR = 0.81 (95% CI = 0.27–2.45, P = 0.71, Tau 2 = 0.00, I 2 = 0%) compared with carbapenem monotherapy. Compared with combination with tigecycline or carbapenem, Colistin monotherapy resulted in OR of 3.07 (95% CI = 1.34–7.04, P = 0.008, Tau 2 = 0.00, I 2 = 0%) and 0.98 (95%CI = 0.29–3.31, P = 0.98, Tau 2 = 0.00, I 2 = 0% ), respectively. Conclusions Colistin, carbapenem and tigecycline monotherapy showed similar treatment effects in patients who suffered from BSI-KP. Compared with colistin monotherapy, colistin combined tigecycline therapy might play the synergism effects. Trial registration retrospectively registered.https://doi.org/10.1186/s12879-024-09024-6Bloodstream infection of Klebsiella pneumoniaeColistinSystematic reviewmeta-analysis |
| spellingShingle | Tao Wang Hongcheng Liu Huiqing Huang Yuesong Weng Xiaojun Wang Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis BMC Infectious Diseases Bloodstream infection of Klebsiella pneumoniae Colistin Systematic review meta-analysis |
| title | Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis |
| title_full | Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis |
| title_fullStr | Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis |
| title_full_unstemmed | Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis |
| title_short | Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis |
| title_sort | colistin monotherapy or combination for the treatment of bloodstream infection caused by klebsiella pneumoniae a systematic review and meta analysis |
| topic | Bloodstream infection of Klebsiella pneumoniae Colistin Systematic review meta-analysis |
| url | https://doi.org/10.1186/s12879-024-09024-6 |
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