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Meta-Analysis
. 2024 Jan 19;103(3):e36938.
doi: 10.1097/MD.0000000000036938.

Effectiveness and safety of cefotaxime combined with avibactam for treating multidrug-resistant E coli infections: A systematic review and meta-analysis

Geming Liu  1 , Jia Qiu  2 , Yang Liu  3 , Zhisen Liu  4
Affiliations
Meta-Analysis

Effectiveness and safety of cefotaxime combined with avibactam for treating multidrug-resistant E coli infections: A systematic review and meta-analysis

Geming Liu et al. Medicine (Baltimore). .

Abstract

Background: Multidrug-resistant Escherichia coli infections are a global health challenge, notably in North America, Europe, Asia, and Africa. This systematic review and meta-analysis evaluates the effectiveness and safety of cefotaxime combined with avibactam, aiming to mitigate these infections' impact and lessen their burden on healthcare systems worldwide.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and PICO frameworks, we conducted a comprehensive literature search across 4 primary databases on May 6, 2023. Studies evaluating the efficacy and safety of cefotaxime and avibactam were included. Key outcomes included treatment success, adverse effects, and microbiological eradication. Quality assessment utilized the Cochrane Collaboration Risk of Bias instrument. Heterogeneity was analyzed using chi-square statistics and the I2 index. Both fixed- and random-effects models were applied as appropriate. Publication bias was rigorously evaluated using Egger linear regression test and funnel plot analysis, ensuring the study's integrity and reliability.

Results: The clinical cure rate derived from 8 studies showed no significant difference between the treatment groups (odds ratio [OR] = 1.97, 95% CI: 0.69 to 1.36, P = .86). Analysis of the bacterial clearance rate from the 5 studies also indicated no significant difference (OR = 0.97, 95% CI: 0.42 to 2.25, P = .36). Notably, a reduced mortality rate favoring the experimental group was observed in 6 studies (OR = 0.64, 95% CI: 0.44 to 0.92, P = .012). Comprehensive sensitivity analyses and the assessment of publication bias strengthened the reliability of the results.

Conclusions: Ceftazidime combined with avibactam significantly reduced mortality among patients with multidrug-resistant Escherichia coli infections, indicating its potential as a therapeutic option, especially for carbapenem-resistant Enterobacteriaceae. However, extensive large-scale clinical trials are required to validate these findings.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Selection process of included studies.
Figure 2.
Figure 2.
Quality assessment of included studies using Cochrane Collaboration’s tool criteria. Red in figure indicates high risk, yellow represents unclear risk and green means low risk.
Figure 3.
Figure 3.
Forest plots of the clinical cure rate.
Figure 4.
Figure 4.
Forest plots of the bacterial clearance rate.
Figure 5.
Figure 5.
Forest plots of the mortality rate.
Figure 6.
Figure 6.
Sensitivity analysis on clinical cure rate.
Figure 7.
Figure 7.
Funnel plot for publication bias in all included studies.
See this image and copyright information in PMC

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