scholarly journals Intravenous colistin use for infections due to multidrug-resistant gram-negative bacilli in critically ill paediatric patients: a systematic review and meta-analysis

2018 ◽  
Author(s):  
Spyridon A. Karageorgos ◽  
Hamid Bassiri ◽  
George Siakallis ◽  
Michael Miligkos ◽  
Constantinos Tsioutis
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Age Groups ◽  
Clinical Effectiveness ◽  
Multidrug Resistant ◽  
Loading Dose ◽  
Gram Negative ◽  
Paediatric Patients ◽  
Tract Infections

SynopsisBackgroundData are limited regarding the clinical effectiveness and safety of intravenous colistin for treatment of infections by multidrug-resistant gram-negative bacilli (MDR-GNB) in the paediatric intensive care unit (PICU).MethodsSystematic review of intravenous colistin use in critically ill paediatric patients with MDR-GNB infection in PubMed, Scopus and Embase (through January 31st, 2018).ResultsOut of 1,181 citations, 7 studies were included on the use of intravenous colistin for 405 patients in PICU. Majority of patients were diagnosed with lower respiratory tract infections, with Acinetobacter baumannii being the predominant pathogen. Colistin dosages ranged between 2.6-18 mg/kg/day, with none but one case reporting a loading dose. Emergence of colistin-resistance during treatment was reported in two cases. Nephrotoxicity and neurotoxicity were reported in 6.1% and 0.5% respectively, but concomitant medications and severe underlying illness limited our ability to definitively associate use of colistin with nephrotoxicity. Crude mortality was 29.5% (95%CI 21.7-38.1%), whereas infection-related mortality was 16.6% (95%CI 12.2-21.5%).ConclusionsWhile the reported incidence of adverse events related to colistin were low, reported mortality rates for infections by MDR-GNB in PICU were notable. In addition to severity of disease and comorbidities, inadequate daily dosage and the absence of a loading dose may have contributed to mortality. As the use of colistin for treatment of MDR-GNB infections increases, it is imperative to understand whether optimal dosing of colistin in paediatric patients differs across different age groups. As such, future studies to establish the pharmacokinetic properties of colistin in different paediatric settings are warranted.

Intravenous colistin use for infections due to MDR Gram-negative bacilli in critically ill paediatric patients: a systematic review and meta-analysis

2019 ◽  
Vol 74 (9) ◽  
pp. 2497-2506 ◽  
Author(s):  
Spyridon A Karageorgos ◽  
Hamid Bassiri ◽  
George Siakallis ◽  
Michael Miligkos ◽  
Constantinos Tsioutis
Keyword(s):  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Age Groups ◽  
Clinical Effectiveness ◽  
Loading Dose ◽  
Gram Negative ◽  
Paediatric Patients ◽  
Optimal Dosing ◽  
Tract Infections

Abstract Background Data are limited regarding the clinical effectiveness and safety of intravenous colistin for treatment of infections due to MDR Gram-negative bacilli (GNB) in paediatric ICUs (PICUs). Methods Systematic review of intravenous colistin use in critically ill paediatric patients with MDR-GNB infection in PubMed, Scopus and EMBASE (up to 31 January 2018). Results Out of 1181 citations, 7 studies were included on the use of intravenous colistin for 405 patients in PICUs. The majority of patients were diagnosed with lower respiratory tract infections, Acinetobacter baumannii being the predominant pathogen. Colistin dosages ranged between 2.6 and 18 mg/kg/day, with only one case reporting a loading dose. Emergence of colistin resistance during treatment was reported in two cases. Nephrotoxicity and neurotoxicity were reported in 6.1% and 0.5%, respectively, but concomitant medications and severe underlying illness limited our ability to definitively associate use of colistin with nephrotoxicity. Crude mortality was 29.5% (95% CI = 21.7%–38.1%), whereas infection-related mortality was 16.6% (95% CI = 12.2%–21.5%). Conclusions While the reported incidence of adverse events related to colistin was low, reported mortality rates for infections due to MDR-GNB in PICUs were notable. In addition to severity of disease and comorbidities, inadequate daily dosage and the absence of a loading dose may have contributed to mortality. As the use of colistin for treatment of MDR-GNB infections increases, it is imperative to understand whether optimal dosing of colistin in paediatric patients differs across different age groups. Thus, future studies to establish the pharmacokinetic properties of colistin in different paediatric settings are warranted.

scholarly journals Modifiable risk factors for multidrug‐resistant Gram‐negative infection in critically ill burn patients: a systematic review and meta‐analysis

2019 ◽  
Vol 89 (10) ◽  
pp. 1256-1260 ◽  
Author(s):  
Mark L. Vickers ◽  
Eva Malacova ◽  
Gabriel J. Milinovich ◽  
Patrick Harris ◽  
Lars Eriksson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Critically Ill ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Modifiable Risk Factors ◽  
Burn Patients ◽  
Gram Negative

scholarly journals Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis

Antibiotics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 14
Author(s):  
Tommaso Cai ◽  
Umberto Anceschi ◽  
Irene Tamanini ◽  
Serena Migno ◽  
Michele Rizzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Medical Device ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Adult Women ◽  
End Of Treatment ◽  
Significant Difference ◽  
Clinically Significant ◽  
Tract Infections ◽  
Uncomplicated Cystitis

Background: In the era of antibiotic resistance, an antibiotic-sparing approach presents an interesting alternative treatment of uncomplicated cystitis in women. Our aim is to perform a systematic review and meta-analysis to compare the effectiveness and safety profile of a medical device containing xyloglucan, hibiscus and propolis (XHP) in women with uncomplicated cystitis. Methods: Relevant databases were searched using methods recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary endpoint was clinical or microbiological success, defined as the complete (cure) and/or non-complete (improvement) resolution of symptoms at the end of treatment, or microbiological resolutions. Results: After screening 21 articles, three studies were included, recruiting a total of 178 patients. All three studies used placebo as comparator. A statistically significant difference was found in terms of clinical or microbiological resolution between the medical device and the comparator (3 RCTs, 178 patients, OR: 0.13; 95% CI: 0.05–0.33; p < 0.0001). No clinically significant adverse effects have been reported. Conclusion: A medical device containing xyloglucan, hibiscus and propolis is superior to comparator regimens in terms of clinical effectiveness in adult women with microbiologically confirmed or clinical suspicion of uncomplicated cystitis and is associated with a high patient compliance.

scholarly journals Monotherapy versus combination therapy for multidrug-resistant Gram-negative infections: Systematic Review and Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Adrian Schmid ◽  
Aline Wolfensberger ◽  
Johannes Nemeth ◽  
Peter W. Schreiber ◽  
Hugo Sax ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Meta Analysis ◽  
Blood Stream ◽  
Multidrug Resistant ◽  
Case Control ◽  
Gram Negative Bacteria ◽  
Case Control Studies ◽  
Gram Negative ◽  
Cure Rates

Abstract Infections caused by carbapenemase-producing, multidrug-resistant (MDR), or extensively drug-resistant (XDR) Gram-negative bacteria constitute a major therapeutic challenge. Whether combination antibiotic therapy is superior to monotherapy remains unknown. In this systematic review and meta-analysis OVID MEDLINE, EMBASE, PubMed, The Cochrane Library, and Scopus databases were searched for randomized controlled trials (RCTs) and observational studies published by December 2016 comparing mono- with combination antibiotic therapy for infections with carbapenemase-producing, MDR, or XDR Gram-negative bacteria. Mortality and clinical cure rates served as primary and secondary outcome measures, respectively. Of 8847 initially identified studies, 53 studies – covering pneumonia (n = 10 studies), blood stream (n = 15), osteoarticular (n = 1), and mixed infections (n = 27) - were included. 41% (n = 1848) of patients underwent monotherapy, and 59% (n = 2666) combination therapy. In case series/cohort studies (n = 45) mortality was lower with combination- vs. monotherapy (RR 0.83, CI 0.73–0.93, p = 0.002, I2 = 24%). Subgroup analysis revealed lower mortality with combination therapy with at least two in-vitro active antibiotics, in blood stream infections, and carbapenemase-producing Enterobacteriaceae. No mortality difference was seen in case-control studies (n = 6) and RCTs (n = 2). Cure rates did not differ regardless of study type. The two included RCTs had a high and unknown risk of bias, respectively. 16.7% (1/6) of case-control studies and 37.8% (17/45) of cases series/cohort studies were of good quality, whereas quality was poor in the remaining studies. In conclusion, combination antimicrobial therapy of multidrug-resistant Gram-negative bacteria appears to be superior to monotherapy with regard to mortality.

Efficacy and Safety of a Colistin Loading Dose, High-Dose Maintenance Regimen in Critically Ill Patients With Multidrug-Resistant Gram-Negative Pneumonia

2016 ◽  
Vol 32 (8) ◽  
pp. 487-493 ◽  
Author(s):  
Jessica L. Elefritz ◽  
Karri A. Bauer ◽  
Christian Jones ◽  
Julie E. Mangino ◽  
Kyle Porter ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Clinical Cure ◽  
Statistical Significance ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Multidrug Resistant ◽  
High Dose ◽  
Loading Dose ◽  
Gram Negative

Introduction: Emergence of multidrug-resistant (MDR) gram-negative (GN) pathogens and lack of novel antibiotics have increased the use of colistin, despite unknown optimal dosing. This study aimed to evaluate the safety and efficacy of a colistin loading dose, high-dose (LDHD) maintenance regimen in patients with MDR-GN pneumonia. Methods: A retrospective cohort analysis was performed comparing critically ill patients with MDR-GN pneumonia pre- and postimplementation of a colistin LDHD guideline with a primary outcome of clinical cure. Safety was assessed using incidence of acute kidney injury (AKI) based on RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria. Results: Seventy-two patients met the inclusion criteria (42 preimplementation and 30 postimplementation). Clinical cure was achieved in 23 (55%) patients in the preimplementation group and 20 (67%) patients in the postimplementation group ( P = .31). AKI occurred in 50% of the patients during the preimplementation period and 58% during the postimplementation period ( P = .59) with no difference in initiation rates of renal replacement therapy. Conclusion: The increased clinical cure rate after implementation of the colistin LDHD guideline did not reach statistical significance. The LDHD guideline, however, was not associated with an increased incidence of AKI, despite higher intravenous colistin doses. Opportunity exists to optimize colistin dosage while balancing toxicity, but larger studies are warranted.

scholarly journals Risk Factors of Multidrug-Resistant Bacteria in Lower Respiratory Tract Infections: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Gang Chen ◽  
Kailiang Xu ◽  
Fangyuan Sun ◽  
Yuxia Sun ◽  
Ziyuan Kong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Cochrane Library ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background. Multidrug-resistant (MDR) bacteria are the main cause of lower respiratory tract infections (LRTIs) with high mortality. The purpose of this study is to identify the risk factors associated with MDR by performing a systematic review and meta-analysis. Methods. PubMed, EMBASE (via Ovid), and Cochrane Library were systematically searched for studies on the risk factors for MDR bacteria in LRTIs as of November 30, 2019. Literature screening, data abstraction, and quality assessment of the eligible studies were performed independently by two researchers. Results. A total of 3,607 articles were retrieved, of which 21 articles representing 20 cohort studies published in English were included after title/abstract and full-text screening. Among the 21 articles involving 7,650 patients and 1,360 MDR organisms, ten reported the risk factors for MDR Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), ten for MDR GNB, and one for MDR GPB. The meta-analysis results suggested that prior antibiotic treatment, inappropriate antibiotic therapy, chronic lung disease, chronic liver disease and cerebral disease, prior MDR and PA infection/colonization, recent hospitalization, longer hospitalization stay, endotracheal tracheostomy and mechanical ventilation, tube feeding, nursing home residence, and higher disease severity score were independent risk factors for MDR bacteria. Conclusions. This review identified fourteen clinical factors that might increase the risk of MDR bacteria in patients with LRTIs. Clinicians could take into account these factors when selecting antibiotics for patients and determine whether coverage for MDR bacteria is required. More well-designed studies are needed to confirm the various risk factors for MDR bacteria in the future.

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