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To distinguish between safety and efficacy of Cefiderocol- versus Colistin-based treatment (comprising of other antibiotics) for treating carbapenem-resistant Acinetobacter baumannii (CRAB) infections.
Cefiderocol reduces mortality in Acinetobacter baumannii infections in adults, particularly bloodstream infections, but offers no advantage in cure rates or acute kidney injury risk.
To distinguish between safety and efficacy of Cefiderocol- versus Colistin-based treatment (comprising of other antibiotics) for treating carbapenem-resistant Acinetobacter baumannii (CRAB) infections.
Independent searches were performed on PubMed, Web of Science, Embase, and Cochrane databases by 2 authors up to April 2024 to find suitable randomized trials and cohort studies comparing antibiotic therapies comprising Cefiderocol and Colistin for CRAB infections. Study quality was determined via the Newcastle-Ottawa Scale. The main outcome was all-cause mortality, with subgroup analyses conducted based on infection site and risk of study bias.
In this systematic review and meta-analysis, 6 observational studies were counted (251 patients receiving Cefiderocol-based and 372 receiving Colistin-based treatment). Compared to the Colistin group, the Cefiderocol group showed a lower all-cause mortality rate (Risk Ratio [RR] = 0.71, 95% Confidence Interval (CI): 0.54–0.92, P = 0.01) and reduced mortality at day 30 (RR = 0.64, 95% CI: 0.43–0.95, P = 0.03). However, no substantial discrepancies in 14- or 28-day mortality rates between the groups were noted.
Cefiderocol lowered all-cause mortality in volunteers with bloodstream infections but did not significantly lessen mortality in volunteers having ventilator-associated pneumonia. The reliability of these results was confirmed by the trial sequential analysis. Microbiological cure rates, clinical cure rates, or hospital stay duration did not vary substantially. Cefiderocol was not linked with any risk of acute renal failure.
A significantly lower risk of mortality in CRAB-infected patients, particularly in those with bloodstream infections was associated with Cefiderocol-based regimens when compared to Colistin-based regimens. Nevertheless, they offered no significant advantages in terms of clinical or microbiological cure rates and did not reduce the occurrence of acute renal failure.
BMC Infectious Diseases
Comparison of cefiderocol and colistin-based regimens for the treatment of severe infections caused by carbapenem-resistant Acinetobacter baumannii: a systematic review with meta-analysis and trial sequential analysis
Yangyang Zhan et al.
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