Doripenem in the Treatment of Patients with Nosocomial Pneumonia: A Meta-Analysis

Abstract

Introduction: Clinically, doripenem therapy for nosocomial pneumonia remains a serious concern. The purpose of this meta-analysis was to explore the efficacy and the safety of doripenem therapy for nosocomial pneumonia in comparison with other antimicrobial agents.

Methods: Studies were eligible for inclusion only if they directly compared the clinical effectiveness of doripenem and other antimicrobial agent therapies for nosocomial pneumonia in adult patients between 1 January 2000 and 30 April 2022. All studies were included if they reported one or more of the following outcomes: clinical cure rate, microbiological cure rate, all-cause mortality, and adverse events.

Results: Six randomized controlled trials and three retrospective studies were included in the meta-analysis. There were 952 patients in the doripenem group and 1183 patients in the comparator group. The comparator antimicrobial agents included imipenem/cilastatin, meropenem, and piperacillin/tazobactam. Seven studies had a high risk of bias. Doripenem therapy for nosocomial pneumonia had a microbiological cure rate, a clinical cure rate, an all-cause mortality, and adverse events similar to those of comparators.

Conclusions: The efficacy and the safety of doripenem therapy for nosocomial pneumonia were comparable with those of comparators. Randomized controlled trials are needed to confirm the role of doripenem in nosocomial pneumonia therapy.

Keywords: Pseudomonas aeruginosa; doripenem; hospital-acquired pneumonia; ventilator-associated pneumonia.

Figure 1

Flow diagram of the study selection process.

Figure 2

Risk of bias of six randomized controlled trials included in the meta-analysis [6,15,16,17,18,19].

Figure 3

Microbiological cure rate between doripenem and comparator antimicrobial agents in nosocomial pneumonia patients. Four studies involving 882 patients (449 receiving doripenem therapy, 433 receiving other antimicrobial agent therapy) reported microbiological cure rates [15,16,17,18].

Figure 3

Microbiological cure rate between doripenem and comparator antimicrobial agents in nosocomial pneumonia patients. Four studies involving 882 patients (449 receiving doripenem therapy, 433 receiving other antimicrobial agent therapy) reported microbiological cure rates [15,16,17,18].

Figure 4

Clinical cure rate between doripenem and comparator antimicrobial agents in nosocomial pneumonia patients. In total, 7 studies involving 1738 patients (863 receiving doripenem therapy, 875 receiving other antimicrobial agent therapy) reported clinical cure rates [6,15,16,17,18,19,21].

Figure 5

All-cause mortality between doripenem and comparator antimicrobial agents in nosocomial pneumonia patients. Six studies involving 1952 patients (865 receiving doripenem therapy, 1087 receiving other antimicrobial agent therapies) reported all-cause mortality [6,17,18,19,21,22].

Figure 6

Adverse events between doripenem and comparator antimicrobial agents in nosocomial pneumonia patients. In total, 3 studies involving 1186 patients (596 receiving doripenem therapy, 590 receiving other antimicrobial agent therapies) reported adverse events [15,17,18].

Figure 6

Adverse events between doripenem and comparator antimicrobial agents in nosocomial pneumonia patients. In total, 3 studies involving 1186 patients (596 receiving doripenem therapy, 590 receiving other antimicrobial agent therapies) reported adverse events [15,17,18].

Figure 7

Microbiological cure rate between doripenem and comparator antimicrobial agents in Pseudomonas aeruginosa pneumonia patients. A total of 3 studies involving 77 patients (42 receiving doripenem therapy, 35 receiving other antimicrobial agent therapies) reported PA pneumonia microbiological cure rates [15,17,18].

Figure 7

Microbiological cure rate between doripenem and comparator antimicrobial agents in Pseudomonas aeruginosa pneumonia patients. A total of 3 studies involving 77 patients (42 receiving doripenem therapy, 35 receiving other antimicrobial agent therapies) reported PA pneumonia microbiological cure rates [15,17,18].

Figure 8

Clinical cure rate between doripenem and comparator antimicrobial agents in Pseudomonas aeruginosa pneumonia patients. A total of 3 studies involving 149 patients (69 receiving doripenem therapy, 80 receiving other antimicrobial agent therapies) reported PA pneumonia clinical cure rates [16,18,20].

Figure 9

All-cause mortality between doripenem and comparator antimicrobial agents in Pseudomonas aeruginosa pneumonia patients. A total of 2 studies involving 115 patients (49 receiving doripenem therapy, 66 receiving other antimicrobial agent therapies) reported PA pneumonia all-cause mortality [16,20].