Objectives: To perform a systematic review with meta-analysis for assessing the clinical efficacy of cefiderocol-based regimens for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections. Methods: Two authors independently searched PubMed-MEDLINE, Scopus, and Cochrane database up to 02 July 2023, to retrieve randomized controlled trials (RCTs) or observational studies comparing clinical efficacy of cefiderocol-based regimens in patients affected by CRAB infections compared to those treated with non-cefiderocol-based regimens. Data were independently extracted by the two authors, and the quality of included studies was independently assessed according to ROB 2.0 or ROBINS-I tools. Mortality rate was selected as primary outcome. Meta-analysis was performed by pooling ORs retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method. Multiple subgroups and sensitivity analyses were conducted to investigate the source of heterogeneity. Results: A total of 530 articles were screened, and 6 studies (one RCT and five observational; N=561; 247 cefiderocol-based regimens vs. 314 non-cefiderocol-based regimens) were included. Cefiderocol did not significantly reduce in-hospital mortality compared to alternative therapies (predominantly colistin based), but the confidence intervals around the effect estimate includes a clinically important benefit (N=5; OR 0.64; 95%CI 0.40-1.04; I2=57.5%). When only observational studies providing adjustment for confounders were considered, a lower risk of mortality rate was found in patients treated with cefiderocol-based regimens (N=4; OR 0.53; 95%CI 0.39-0.71; I2=0.0%). Conclusions: Cefiderocol-based regimens were associated with a significant lower risk of mortality rate in patients affected by CRAB infections in observational studies providing proper adjustment for confounders.
Gatti, M., Cosentino, F., Giannella, M., Viale, P., Pea, F. (2024). Clinical efficacy of cefiderocol-based regimens in patients affected by carbapenem-resistant Acinetobacter baumannii infections: a systematic review with meta-analysis. INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, 63(2), 1-5 [10.1016/j.ijantimicag.2023.107047].
Clinical efficacy of cefiderocol-based regimens in patients affected by carbapenem-resistant Acinetobacter baumannii infections: a systematic review with meta-analysis
Gatti, Milo
;Cosentino, Federica;Giannella, Maddalena;Viale, Pierluigi;Pea, Federico
2024
Abstract
Objectives: To perform a systematic review with meta-analysis for assessing the clinical efficacy of cefiderocol-based regimens for the treatment of carbapenem-resistant Acinetobacter baumannii (CRAB) infections. Methods: Two authors independently searched PubMed-MEDLINE, Scopus, and Cochrane database up to 02 July 2023, to retrieve randomized controlled trials (RCTs) or observational studies comparing clinical efficacy of cefiderocol-based regimens in patients affected by CRAB infections compared to those treated with non-cefiderocol-based regimens. Data were independently extracted by the two authors, and the quality of included studies was independently assessed according to ROB 2.0 or ROBINS-I tools. Mortality rate was selected as primary outcome. Meta-analysis was performed by pooling ORs retrieved from studies providing adjustment for confounders using a random-effects model with the inverse variance method. Multiple subgroups and sensitivity analyses were conducted to investigate the source of heterogeneity. Results: A total of 530 articles were screened, and 6 studies (one RCT and five observational; N=561; 247 cefiderocol-based regimens vs. 314 non-cefiderocol-based regimens) were included. Cefiderocol did not significantly reduce in-hospital mortality compared to alternative therapies (predominantly colistin based), but the confidence intervals around the effect estimate includes a clinically important benefit (N=5; OR 0.64; 95%CI 0.40-1.04; I2=57.5%). When only observational studies providing adjustment for confounders were considered, a lower risk of mortality rate was found in patients treated with cefiderocol-based regimens (N=4; OR 0.53; 95%CI 0.39-0.71; I2=0.0%). Conclusions: Cefiderocol-based regimens were associated with a significant lower risk of mortality rate in patients affected by CRAB infections in observational studies providing proper adjustment for confounders.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
