• I-Ling Cheng, Yu-Hung Chen, Chih-Cheng Lai, and Hung-Jen Tang.
• Department of Pharmacy, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan. bokey1010@gmail.com.
• J Clin Med. 2018 Aug 10; 7 (8).

AbstractThis 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.

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