Efficacy and safety of different polymyxin-containing regimens for the treatment of pneumonia caused by multidrug-resistant gram-negative bacteria: a systematic review and network meta-analysis
Pooled result · Overall mortalityResult — go to the resultOdds ratio 0.67 95% CI 0.50–0.88Authors' conclusion
Our study indicates that among the three administration regimens, the IV + IH polymyxin-containing regimen may be the most effective for treating MDR-GNB pneumonia, with a significantly lower overall mortality compared to the IV regimen and a considerably higher microbial eradication rate compared to the IH regimen.
Study context
- Population
- Patients with multidrug-resistant gram-negative bacterial (MDR-GNB) pneumonia
- Participants
- 3,318 patients · 19 observational studies · 3 randomized controlled trials (RCTs)
- Comparison
- Intravenous (IV) + inhaled (IH) vs IH vs IV polymyxin-containing regimens
- Outcome
- Overall mortality
Methodological detailspairwise and network meta-analyses, observational studies and RCTs, Risk of bias assessed with Cochrane RoB 2 (randomised trials) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) (cohort studies)
- Pairwise and network meta-analyses
- Observational studies and RCTs
- Risk of bias assessed with Cochrane RoB 2 (randomised trials) and ROBINS-I (cohort studies)
Pooled result
As reported in the abstract
Odds ratio
0.67
95% CI 0.50–0.88
IV + IH vs IV
OR 0.67 (95% CI 0.50–0.88)
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| Clinical success (network meta-analysis)IV + IH vs IV · higher clinical success rate | OR for clinical success 1.90 (95% CI 1.20–3.00) | |
| Microbial eradication (network meta-analysis)IV + IH vs IV · better microbial eradication rate | OR for microbial eradication 2.70 (95% CI 1.90–3.90) | |
| Microbial eradication (network meta-analysis)IV + IH vs IH · significantly better microbial eradication rate | OR for microbial eradication 2.30 (95% CI 1.30–4.20) | |
| 0.20.5125Ratio (log scale) |
Overall mortality (pairwise meta-analysis)
- IV + IH vs IV: significant decrease in overall mortality
- IH vs IV: no statistically significant difference
Safety
- IH showed a significant reduction in AKI vs IV + IH and IV
Original publication
Efficacy and safety of different polymyxin-containing regimens for the treatment of pneumonia caused by multidrug-resistant gram-negative bacteria: a systematic review and network meta-analysis. Crit Care. Published 14 July 2024. doi:10.
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