[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Antibiotic treatment of infections due to carbapenem-resistant Enterobacteriaceae: systematic evaluation of the available evidence

Matthew E. Falagas, MD, MSc, DSc 1,2,3, Panagiota Lourida, MD, DSc 1, Panagiotis Poulikakos, MD 1,2, Petros I. Rafailidis, MD, MSc 1 and Giannoula S. Tansarli, MD 1

Author Affiliations: <SUP>1</SUP>Alfa Institute of Biomedical Sciences (AIBS), Marousi, Athens, Greece; <SUP>2</SUP>Department of Internal Medicine - Infectious Diseases, Mitera Hospital, Hygeia Group, Athens, Greece; <SUP>3</SUP>Tufts University School of Medicine, Boston, Massachusetts, USA



We sought to evaluate the effectiveness of the antibiotic treatment administered for infections caused by carbapenemase-producing Enterobacteriaceae.


PubMed and Scopus databases were systematically searched. Articles reporting the clinical outcomes of patients infected with carbapenemase-producing Enterobacteriaceae according to the antibiotic treatment administered were eligible.


Twenty non-randomized studies comprising 692 patients who received definitive treatment were included. Almost all studies reported on Klebsiella spp. In 8 studies, the majority of infections were bacteremia, while pneumonia and urinary tract infections were the most common infections in 12 studies. In 10 studies, the majority of patients were critically ill. There are methodological issues, including clinical heterogeneity, that preclude the synthesis of the available evidence using statistical analyses including meta-analysis. From the descriptive point of view, among patients who received combination treatment, mortality was up to 50% for tigecycline-gentamicin combination, up to 64% for tigecycline-colistin, and up to 67% for carbapenem-colistin. Among the monotherapy-treated patients, mortality was up to 57% for colistin and up to 80% for tigecycline. Certain regimens were administered to a small number of patients in certain studies. Three studies reporting on 194 critically ill patients with bacteremia showed individually significantly lower mortality in the combination arm compared to the monotherapy arm. In the other studies, no significant difference in mortality was recorded between the compared groups.


Combination antibiotic treatment may be considered the optimal option for severely ill patients with severe infections. However, well-designed randomized studies in specific patient populations are needed to further clarify this issue.


Corresponding author: Matthew Ε. Falagas, MD, MSc, DSc, Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece, Tel: +30-694-61.10.000, Fax: +30-210-68.39.605, E-mail: m.falagas@aibs.gr

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