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.
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. - In: INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS. - ISSN 0924-8579. - ELETTRONICO. - 63:2(2024), pp. 107047.1-107047.5. [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.
