EFFICACY OF CEFTAZIDIME-AVIBACTAM IN MONOTHERAPY OR COMBINATION THERAPY AGAINST CARBAPENEM RESISTANT GRAM NEGATIVE ORGANISMS: A META-ANALYSIS.

Abstract

BACKGROUND\nSeveral clinicians use ceftazidime-avibactam in combination with other active agents to treat infections due to carbapenem-resistant organisms, although no conclusive data support this practice.\n\n\nOBJECTIVE\nThe aim of this meta-analysis was to compare the efficacy of ceftazidime-avibactam used in monotherapy or in combination therapy against infections due to carbapenem-resistant Enterobacteriaceae (CRE) and P. aeruginosa (CRPsA).\n\n\nMETHODS\nTwo researchers conducted a computerized literature search using MEDLINE, Google Scholar and the Cochrane Library to locate observational studies published as full-papers and indexed up to February 2019 that compared the efficacy, in terms of mortality rate and microbiological cure, of ceftazidime/avibactam used in monotherapy or in combination with other active agents for infections due to CRE and CRPsA. We estimated the Risk Ratio (RR) of mortality and of microbiological eradication based on pooled data from all eligible studies.\n\n\nRESULTS\nA total of 11 articles were included in this meta-analysis accounting for 396 subjects, 202 of whom received combination therapy. The mortality rate was 38.1% for combination and 30.9% for monotherapy, with a RR of 1.18 (95% CI 0.88-1.58, p=0.259). Similarly, no difference was found between the 2 groups when we analysed the rate of microbiological cure (64.9% in the combination, 63.4% in the monotherapy group, RR 1.04, 95% CI 0.85-1.28, p=0.705). Again, no difference was observed for both outcomes when we excluded from the analysis the patients infected with P. aeruginosa.\n\n\nCONCLUSIONS\nOur meta-analysis suggested that the use of ceftazidime/avibactam in monotherapy or in combination therapy for the treatment of infections due to CRE or CRPsA could show a similar effect on the mortality rate and microbiological cure. However, studies on a larger samples are needed to address this important issue.