Efficacy Of Monotherapy Versus Combination Therapy Against Carbapenem-resistant Enterobacteriaceae Infections: A Meta-analysis

Objectives To systematically review the efficacy of monotherapy versus combination therapy for treating Carbapenem-resistant Enterobacteriaceae Infections.MethodsOVID MEDLINE,EMBASE,Pub Med,The Cochrane Library,and Scopus databases were searched for randomized controlled trials(RCTs)and observational studies published by February 2020 comparing mono-with combination antibiotic therapy for infections with Carbapenem-resistant Enterobacteriaceae.Mortality,clinical and microbiological respons rates served as primary and secondary outcome measures.Data were analyzed by using Rev Man 5.3.ResultsForty-three studies were included in the meta-analysis,containing 3192 patients,of whom?1394 underwent monotherapy,and 1798 underwent combination therapy.The results of meta-analysis showed that:1、Combination therapy of bloodstream infections caused by carbapenem-resistant Enterobacteriaceae showed lower mortality versus monotherapy(OR =0.96,95%CI 0.77–1.21,P= 0.36).Likewise,there was no significant difference in mortality between monotherapy and combination regimens.Polymyxin-based combination therapy showed lower mortality for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacteriaceae versus Polymyxin monotherapy(OR=0.56,95 % CI : 0.33-0.93,P=0.10).Tigecycline-based combination therapy showed lower mortality for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacteriaceae versus tigecycline monotherapy(OR=0.34,95 % CI : 0.21-0.56,P<0.0001);In the non-bloodstream infection group,Polymyxin-based combination therapy or Tigecycline-based combination therapy did not show a significant difference in mortality versus Polymyxin or Tigecycline combination therapy.2 、There was no significant difference in the clinical response rate between monotherapy and combination regimens(OR=1.01,95% CI:0.65-1.56,P=0.56).3、There was no significant difference in the microbiological response rate between monotherapy and combination regimens(OR=1.01,95% CI:0.65-1.56,P=0.56).ConclusionCompared with monotherapy,combination therapy showed a survival advantage for the treatment of bloodstream infections caused by carbapenem-resistant Enterobacteriaceae.