The efficacy and safety of polymyxins compared with other antibiotics in <i>Acinectobacter baumannii</i> infection.

<p>The efficacy and safety of polymyxins compared with other antibiotics in <i>Acinectobacter baumannii</i> infection.</p

Flow diagram of included studies.

<p>Flow diagram of included studies.</p

Efficacy and Safety of Polymyxins for the Treatment of <i>Acinectobacter baumannii</i> Infection: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>Multi-drug resistance among <i>Acinetobacter baumannii</i> increases the need for polymyxins. We conducted a meta-analysis aimed to assess the efficacy and safety of polymyxins for the treatment of <i>Acinetobacter baumannii</i> infection.</p><p>Methods</p><p>We searched PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, Chinese Biomedical Literature Database up to November 1, 2013, to identify published studies, and we searched clinical trial registries to identify completed unpublished studies. Randomized controlled trials and cohort studies were considered for inclusion. Data were extracted on clinical response, microbiological response, mortality, length of stay and adverse events.</p><p>Results</p><p>12 controlled studies, comparing 677 patients, were included. Although clinical (odds ratio 1.421, 95% confidence interval 0.722–2.797) and microbiological (OR 1.416, 95% CI 0.369–5.425) response rates favored the polymyxins group, these differences were not significant. Treatment with polymyxins vs. controls did not affect hospital mortality (OR 0.506, 95% CI 0.101–2.536), lengths of hospital stay (standard mean difference −0.221, 95% CI 0.899–0.458) or nephrotoxicity (OR 1.192, 95% CI 0.436–3.261). The combination of polymyxins with other antibiotics achieved similar clinical response rates to its monotherapy regimen (OR 0.601, 95% CI 0.320–1.130).</p><p>Conclusions</p><p>Our results suggest that polymyxins may be as safe and as efficacious as standard antibiotics for the treatment of <i>A. baumannii</i> infection. There is no strong evidence that combination regimen of polymyxins is superior to monotherapy regimen.</p></div

The length of stay in hospital of patients when polymyxins were compared with other antibiotics in <i>Acinectobacter baumannii</i> infection.

<p>The length of stay in hospital of patients when polymyxins were compared with other antibiotics in <i>Acinectobacter baumannii</i> infection.</p

The efficacy and safety of polymyxins monotherapy compared with combination treatment in <i>Acinectobacter baumannii</i> infection.

<p>The efficacy and safety of polymyxins monotherapy compared with combination treatment in <i>Acinectobacter baumannii</i> infection.</p

The funnel plot of clinical response rate when polymyxins were compared with other antibiotics in <i>Acinectobacter baumannii</i> infection.

<p>The funnel plot of clinical response rate when polymyxins were compared with other antibiotics in <i>Acinectobacter baumannii</i> infection.</p

Characteristics of Studies Included in Systematic Review and Meta-analysis.

<p>Abbreviation: RCT = randomized controlled trial; VAP = ventilator associated pneumonia; VAT = ventilator associated tracheobronchitis; BSI = bloodstream infection; RTI =  respiratory tract infection; SSII =  skin or soft issue infection; CRI = catheter-related infection; UTI = urinary tract infection; SSI = surgical site infection; CIAI = complicated intra-abdominal infection; HAP = healthcare associated pneumonia; MDRAB = multi-drug resistant <i>Acinetobater baumannii</i>; EDRAB = extensively drug-resistant <i>Acinetobater baumannii</i>; CRAB = carbapenem-resistant <i>Acinetobacter baumannii</i>; AB = <i>Acinetobater bauma.</i></p

Schematic representation IS<i>1R</i>-truncated <i>opmK35</i> gene.

Open reading frames are shown as horizontal boxes with an arrow indicating the orientation of the coding sequence. Duplications of the target site are represented by the vertical line.</p

Meta-analysis results of HLA-DP/DQ and STAT4 polymorphisms with HCC development.

<p>Note: OR, odds ratio; F, fixed-effects model; R, random-effects model.</p><p>Meta-analysis results of HLA-DP/DQ and STAT4 polymorphisms with HCC development.</p

The date, frequency and location of emergence of OXAKp strains with different PFGE types.

<p>The horizontal coordinate shows the date on which OXAKp strains were recovered. The wards were listed in the longitudinal coordinate. SICU: surgical ICU; RICU: respiratory ICU; GAS: gastroenterology department; HEM: hematology department; CAR: cardiovascular department. Clinical isolates with different PFGE types are indicated by various symbols: ●: type A;■: type B; <b>▲</b>: type C; ◆: type D.</p