Systematic review and meta-analysis of colistin plus meropenem therapy for the treatment of nosocomial pneumonia

Hazhir  Moradi; Zahra Sadat Sajadi-Javan; Sarah  Mousavi; Soodabeh  Rostami; Bita Moradi  Khaniabadi

doi:10.18502/ijm.v16i6.17244

Hazhir Moradi Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Zahra Sadat Sajadi-Javan Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Sarah Mousavi Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
Soodabeh Rostami Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Bita Moradi Khaniabadi Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

DOI: https://doi.org/10.18502/ijm.v16i6.17244

Keywords: Meropenem; Colistin; Multiple drug-resistance; Nosocomial infection; Pneumonia

Abstract

Background and Objectives: Nosocomial pneumonia caused by multidrug-resistant gram-negative bacteria presents a sig- nificant challenge for healthcare systems, as there are limited effective treatments available. This systematic review and meta-analysis aim to investigate the outcomes of colistin plus meropenem combination therapy on nosocomial pneumonia.

Materials and Methods: An exhaustive search of PubMed, Scopus, Web of Science (WOS), and Embase databases was conducted, resulting in the extraction of 5 studies for qualitative assessment and meta-analysis. The study sample included

991 patients admitted with nosocomial pneumonia. The outcomes evaluated were clinical improvement, microbiological response, mortality, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Charlson Comorbidity Index (CCI), Clinical Pulmonary Infection Score (CPIS), C-reactive protein (CRP) levels, procalcitonin (PCT) levels, and intensive care unit (ICU) duration.

Results: The results demonstrated that colistin plus meropenem combination therapy significantly improved clinical out- comes (OR = 1.37, 95% CI = 1.04-1.81, p = 0.027), reduced SOFA scores (OR = -0.28, 95% CI = -0.44 to -0.11, p = 0.001), and increased CCI scores (OR = 0.16, 95% CI = 0.02-0.29, p = 0.021) compared to other medications. However, other eval- uated parameters did not show significant differences.

Conclusion: This meta-analysis indicates that colistin-meropenem combination therapy is superior to other colistin-based treatments for nosocomial pneumonia in terms of clinical improvement, SOFA score reduction, and CCI score increase. Nevertheless, other variables assessed did not exhibit remarkable differences between the treatment regimens.