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. 2018 Aug 10;7(8):208.
doi: 10.3390/jcm7080208.

Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials

I-Ling Cheng  1 , Yu-Hung Chen  2 , Chih-Cheng Lai  3 , Hung-Jen Tang  4
Affiliations

Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials

I-Ling Cheng et al. J Clin Med. .

Abstract

This meta-analysis aims to compare intravenous colistin monotherapy and colistin-based combination therapy against carbapenem-resistant gram-negative bacteria (GNB) infections. PubMed, Embase, and Cochrane databases were searched up to July 2018. Only randomized controlled trials (RCTs) evaluating colistin alone and colistin-based combination therapy in the treatment of carbapenem-resistant GNB infections were included. The primary outcome was all-cause mortality. Five RCTs including 791 patients were included. Overall, colistin monotherapy was associated with a risk ratio (RR) of 1.03 (95% confidence interval (CI), 0.89⁻1.20, I² = 0%) for all-cause mortality compared with colistin-based combination therapy. The non-significant difference was also detected in infection-related mortality (RR, 1.23, 95% CI, 0.91⁻1.67, I² = 0%) and microbiologic response (RR, 0.86, 95% CI, 0.72⁻1.04, I² = 62%). In addition, no significant difference was observed in the subgroup analysis-high or low dose, with or without a loading dose, carbapenem-resistant Acinetobacter baumannii infections, and in combination with rifampicin. Finally, colistin monotherapy was not associated with lower nephrotoxicity than colistin combination therapy (RR, 0.98; 95% CI, 0.84⁻1.21, I² = 0%). Based on the analysis of the five RCTs, no differences were found between colistin monotherapy and colistin-based combination therapy against carbapenem-resistant GNB infections, especially for A. baumannii infections.

Keywords: carbapenem-resistant bacteria; colistin; combination therapy; monotherapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Summary of risk of bias.
Figure 3
Figure 3
Risk of bias per study and domain.
Figure 4
Figure 4
Colistin monotherapy versus colistin-based combination therapy, all-cause mortality. M-H, Mantel-Haenszel.
Figure 5
Figure 5
Colistin monotherapy versus colistin-based combination therapy, infection-related mortality. M-H, Mantel-Haenszel.
Figure 6
Figure 6
Colistin monotherapy versus colistin-based combination therapy, microbiologic response. M-H, Mantel-Haenszel.
See this image and copyright information in PMC

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