Background: The best treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still a matter of debate. Objectives: To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT). Data sources: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023. Study eligibility criteria: Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT. Participants: Patients with infections due to CRAB. Interventions: Cefiderocol in monotherapy or in combination with other potentially active agents or BAT. Assessment of risk of bias: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies. Methods of data synthesis: We conducted a meta-analysis pooling risk ratios (RRs) through random effect models. Results: We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38–47%), the rate of microbiological failure 48% (95% CI 31–65%), the clinical failure rate 43% (95% CI 32–55%), and the rate of ADRs was 3% (95% CI 1–6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43–0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57–0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09–0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate. Conclusions: Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections.
Cefiderocol either in monotherapy or combination versus best available therapy in the treatment of carbapenem-resistant Acinetobacter baumannii infections: A systematic review and meta-analysis
Onorato, Lorenzo;de Luca, Ilaria;Coppola, Nicola
2024
Abstract
Background: The best treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections is still a matter of debate. Objectives: To describe the outcomes of patients treated with cefiderocol for CRAB infections, and to compare the efficacy of cefiderocol versus best available therapy (BAT). Data sources: We searched MEDLINE, the Cochrane Library and EMBASE to screen original reports published up to September 2023. Study eligibility criteria: Randomized controlled trials (RCTs) and observational studies investigating 30-day mortality, clinical failure, microbiological failure or rate of adverse drug reactions of patients treated with cefiderocol or BAT. Participants: Patients with infections due to CRAB. Interventions: Cefiderocol in monotherapy or in combination with other potentially active agents or BAT. Assessment of risk of bias: We used the Cochrane Risk of Bias Tool for RCTs, and the Newcastle Ottawa scale for observational studies. Methods of data synthesis: We conducted a meta-analysis pooling risk ratios (RRs) through random effect models. Results: We screened 801 original reports, and 18 studies (2 RCTs, 13 cohort studies and 3 case-series) were included in the analysis, for a total 733 patients treated with cefiderocol, and 473 receiving the BAT. Among patients receiving cefiderocol, the 30-day mortality rate was 42% (95% CI 38–47%), the rate of microbiological failure 48% (95% CI 31–65%), the clinical failure rate 43% (95% CI 32–55%), and the rate of ADRs was 3% (95% CI 1–6%). A lower mortality rate was observed among patients receiving cefiderocol monotherapy as compared to those treated with combination regimens (RR: 0.64; 95% CI: 0.43–0.94, p = 0.024). We found a significantly lower mortality rate (RR: 0.74; 95% CI: 0.57–0.95, p = 0.02) and a lower rate of ADRs (RR: 0.28; 95% CI: 0.09–0.91, p = 0.03) in the group treated with cefiderocol as compared to BAT. No difference was observed in microbiological and clinical failure rate. Conclusions: Our data strengthen the efficacy and safety profile of cefiderocol in CRAB infections.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
