Comparative Effectiveness of Single, Dual, and Multi-Antibiotic Therapies in Managing Carbapenem-Resistant Enterobacterales: A Systematic Review and Meta-Analysis on Survival Rates
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Résumé
Carbapenem-resistant Enterobacterales (CRE) represent a major global health issue, linked to elevated rates of morbidity and mortality stemming from restricted treatment alternatives. The Gram-negative bacteria, such as Klebsiella pneumoniae and Escherichia coli, are significant contributors to severe infections, including bacteremia, pneumonia, and urinary tract infections. Mechanisms of resistance such as the production of carbapenemases, the action of efflux pumps, and mutations in porins diminish the effectiveness of carbapenems, which are frequently the antibiotics of last resort. In light of this escalating concern, the absence of a universally recognized global guideline for the management of CRE results in diverse treatment strategies. This systematic review and meta-analysis aimed to evaluate the effectiveness of monotherapy, dual therapy, and multi-antibiotic regimens in the treatment of CRE infections. In accordance with established guidelines, data from 5 major databases were analyzed, and the quality of the studies was evaluated using the Newcastle-Ottawa Scale. The findings indicated that combination therapy led to a notable enhancement in survival rates when contrasted with monotherapy (OR = 0.69, 95 % CI 0.62 - 0.78, p < 0.00001). In contrast, no significant difference was found between dual therapy and multi-antibiotic regimens (OR = 1.17, 95 % CI 0.95 - 1.46, p = 0.15). The combination therapy exhibited synergistic effects, improving bacterial eradication while reducing the emergence of resistance. Dual therapy demonstrated superior outcomes when contrasted with multi-antibiotic regimens, presenting lower toxicity risks and enhanced patient adherence. Nonetheless, the absence of stratification considering resistance mechanisms, infection severity, and patient characteristics highlights the necessity for tailored treatment strategies. In conclusion, this study emphasizes the critical necessity for internationally standardized protocols for CRE management to guarantee uniform and effective treatment. Future investigations should concentrate on resistance profiling, assessing the safety and cost-effectiveness of dual and multi-antibiotic regimens, and customizing therapies to individual patient factors to enhance outcomes. HIGHLIGHTS This article presents a systematic review and meta-analysis on the effectiveness of antibiotic strategies in managing carbapenem-resistant Enterobacterales (CRE) infections. Combination antibiotic therapy significantly improves patient survival rates compared to monotherapy in CRE infections. No statistically significant difference in survival was observed between dual-antibiotic and multi-antibiotic regimens, though dual therapy demonstrated clinical advantages. This review suggests that Dual therapy offers reduced toxicity risk and improved patient adherence, making it a safer and more feasible option than multiple-antibiotic regimens. The study emphasizes the need for globally standardized CRE treatment protocols and future research that incorporates resistance profiles and patient-specific factors. GRAPHICAL ABSTRACT
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle