Table 1 Characteristics of studies included in the meta-analysis
Author, year | Type of study | Male (n, %) | Organisms | Susceptibility (breakpoints) | Style of infection (%) | Treatment (CT) | Number of patients |
|---|---|---|---|---|---|---|---|
Lee 2020 | Single-center, retrospective study | 109 (64) | CRKP | MIC ≥ 2 for ertapenem or ≥ 4 mg/L for meropenem, or imipenem | Bacteremia (100) | More than one agent as 72 h after bacteremia onset | 140 |
Qureshi 2012 | Multicenter, retrospective study | 15 (44) | CRKP | the breakpoints published by CLSI in 2009 or 2011 | Bacteremia (100) | Two antimicrobials with Gram-negative activity for at least 48Â h after the susceptibility results were available | 34 |
Oliveira 2014 | Multicenter, retrospective study | 62 (53) | CRE | MIC ≥ 4 μg/ml for meropenem or imipenem, MIC ≥ 2 μg/ml, according to 2010 CLSI revised breakpoints | Bacteremia, and others | Use of more than one antimicrobial drug for Gram-negative bacteria | 118 |
Park 2019 | Single-center, retrospective study | 42 (59) | CRAB | NR | Bacteremia (100) | Colistin/meropenem | 71 |
Freire 2019 | Single-center, retrospective study | NR | CRE | NR | UTIs (100) | The use of at least two drugs in the targeted therapy, regardless of their in vitro sensitivity | 23 |
Tuon 2016 | Single-center, retrospective study | NR | CRE | CLSI 2013 | VAP (100) | At least two active drugs | 83 |
Wang 2018 | Multicenter, retrospective study | NR | CRE | CLSI -M7-A10 and CLSI-M100-S28 | Bacteremia (100) | At least two active drugs | 98 |
Önal 2019 | Single-center, retrospective study | 66(66) | CRE | EUCAST criteria | UTIs (100) | At least two drugs | 100 |
LIAO 2015 | Single-center, retrospective study | 79 (76) | CRKP | NR | Sepsis (100) | At least two drugs | 104 |
Tan 2020 | Single-center, retrospective study | 139 (79) | CRGNB | CLSI criteria | BSI (100) | Two or more antibiotics | 175 |
Abdelsalam 2018 | Single-center, prospective randomized study | 28 (47) | CRKP | CLSI 2011 | HAP, VAP | Colistin/meropenem | 60 |
Claudia 2016 | Single-center, retrospective study | 88 (69) | CRE | CLSI 2012 | Pneumonia, UTIs, BSI, tissue infection, IAI, sepsis | The use of more than two drugs | 127 |
Sirijatuphat 2014 | Single-center, prospective RCT study | 44 (47) | CRAB | NR | Pneumonia, BSI, UTIs, skin/ tissue infection, IAI, CNSI, others | Colistin/fosfomycin | 94 |
P.Nadales 2019 | Multicenter, retrospective study | NR | CPE | CLSI 2015 | BSI (100) | It included 2 or more active drugs | 165 |
Wang 2016 | Single-center, prospective study | NR | CRGNB | CLSI | BSI (100) | Two or more active drugs | 138 |
Tumbarello 2012 | Multicenter, retrospective study | 73 (58) | CPKP | CLSI 2011 | BSI (100) | At least 2 vitro-active drugs | 125 |
RIHANI 2012 | Single-center, retrospective study | NR | CPE | CLSI 2010 | BSI, pneumonia, tissue infection, UTIs | 2 or more antimicrobial agents gave simultaneously for at least 48Â h | 22 |
Machuca 2017 | Single-center, prospective study | 57 (55) | CRKP | All the cases MIC ≥ 64 mg/L (high-level meropenem) | Pneumonia, BSI, UTIs | The regimen included 2 or 3 in vitro active drugs | 104 |
L.Corte´s 2014 | Multicenter, retrospective study | NR | CRAB | CLSI 2010 | Pneumonia, tissue and skin infection, UTIs, IAI, and others | Therapy with two or more active drugs | 94 |
Ghafur 2017 | Single-center, retrospective study | 58 (64) | CRGNB | CLSI | BSI (100) | Two or more drugs | 91 |
Tumbarello 2015 | Multicenter, retrospective study | 417 (63) | KPC-producing KPN | EUCAST | BSI (100) | At least two drugs displaying in vitro activity against the isolate | 661 |
Capone 2012 | Multicenter, prospective study | 60 (62) | CRKP | EUCAST | UTIs, BSI, RTI, skin/tissues infection, IAI | Two or more active drugs | 91 |
Katip 2020 | Single-center, retrospective study | 197 (61) | CRAB | CLSI 2015 | Pneumonia, bacteremia, UTIs, others | Colistin/meropenem | 324 |
G.Gutiérrez 2017 | Multicenter, retrospective study | 197 (57) | CPE | CLSI 2012 and local laboratory | BSI (100) | Two or more appropriate drugs | 343 |
Niu 2019 | Single-center, retrospective study | 55 (26) | CRAB | CLSI M100(2018) | BSI (100) | Cefoperazone-sulbactam combination therapy | 75 |
Katip 2020* | Single-center, retrospective study | 90 (36) | CRAB | CLSI M100-S25 | NR | Colistin/meropenem | 248 |
Amat 2017 | Multicenter, retrospective study | 74 (63) | CRAB | CLSI M100-S22 | Bacteremia (100) | Tigecycline/colistin | 118 |
Medeiros 2018 | Single-center, retrospective study | 53 (65) | CPKP | CLSI M100-S21 | BSI (100) | Two or more in vitro active agents | 82 |
G.Simmonds 2016 | Multicenter, retrospective study | 87 (62) | CRKP | CLSI M100-S25 | BSI (100) | SAA plus a BL, MAA without or plus a BL | 141 |
AYDEMIR 2012 | Single-center, prospective RCT | 30 (70) | CRAB | CLSI 2011 | VAP (100) | Colistin and rifampicin | 43 |
Makris 2018 | Multicenter, prospective RCT | 27 (69) | CRAB | NR | VAP (100) | Colistin and ampicillin-sulbactam | 39 |
Shi 2019 | Single-center, prospective study | 114 (71) | CRAB | CLSI M100 | Pneumonia (100) | Colistin and carbapenem | 160 |
Park 2020 | Single-center, prospective study | 70 (83) | CRGNB | Meropenem MIC > 8 mg/L | Bacteremia (100) | Colistin and other antibiotics against G- and/or G + bacteria | 84 |
Paul 2018 | Multicenter, prospective RCT | 151 (37) | CRE | EUCAST 2012 | bacteremia, VAP, HAP, UTIs | Colistin and meropenem | 406 |
Yilmaz 2015 | Single-center, retrospective study | 23 (46) | CRKP | CLSI M100-S21 | VAP (100) | Colistin and carbapenem | 50 |
Zhang 2020 | Single-center, retrospective study | 60 (71) | CRKP | EUCAST | BSI (100) | Two or more drugs | 78 |
Villegas 2016 | Multicenter, retrospective study | NR | CPE | CLSI 2014 | BSI (100) | Two or more active definitive therapy | 37 |
Karaiskos 2020 | Multicenter, prospective study | 109 (74) | CRKP | EUCAST | BSI, UTIs, HAP/VAP, IAI, and others | Targeted therapy CAZ-AVI in combination with at least another active agent | 147 |
Tofas 2016 | Multicenter, retrospective study | NR | CRKP | EUCAST | BSI (100) | Treatment with two or more in vitro active agents | 40 |
Porwal 2014 | Single-center, retrospective study | NR | CRGNB | NR | Bacteremia (100) | Two or more drugs | 41 |
Zhou 2021 | Multicenter, prospective study | NR | Â | CLSI M100 S30 | BSI (100) | More than one in vitro active antimicrobial treatment | 135 |
Tsai 2021 | Single-center, retrospective study | 59(50) | Â | CLSI 2021 | Bacteremia (100) | At least one or more drugs with in vitro activity against the blood isolates | 203 |
Liang 2017 | Multicenter, retrospective study | NR | CRAB | EUCAST | Pneumonia | Two or more drugs | 217 |
Chusri 2019 | Single-center, retrospective study | 16 (57) | CRAB | Carbapenem MIC ≥ 16 μg/ml was used as the resistance breakpoint | IAI (100) | Tigecycline/colistin | 28 |
Tumbarello 2018 | Multicenter, retrospective study | 135 (65) | KPC-KPN | EUCAST | Bacteremia (100) | Two or more drugs | 208 |
Shields 2017 | Single-center, prospective study | NR | CRKP | CLSI | Bacteremia (100) | CAZ-AVI and gentamicin | 13 |
Madeline 2017 | Multicenter, prospective study | 36 (60) | CRE | CLSI 2015 | Bacteremia, UTIs, pneumonia, wound, IAI, bone infection | Â | 60 |
Cristina 2018 | Single-center, retrospective study | 19 (83) | CRE | EUCAST | BSI, UTIs, RTI, Osteomyelitis, IAI | CAZ-AVI with colistin/amikacin/colistin or two of these drugs | 24 |
Daikos 2014 | Multicenter, retrospective study | 103 (59) | CPKP | EUCAST | BSI (100) | Treatment with two or more in vitro active agents | 175 |
G.Padilla 2019 | Single-center, retrospective study | NR | CRKP | EUCAST | Sepsis (100) | Tigecycline/gentamicin | 37 |
Hager 2020 | Single-center, retrospective study | NR | CRGNB | NR | NR | Colistin combination antibiotic regimen | 65 |
D.Mangoni 2013 | Multicenter, RCT | 137 (66) | CRAB | CLSI M100-S20 | VAP, BSI, HAP, complicated IAI | Colistin and rifampicin | 209 |
Li 2024 | Single-center, retrospective study | 62 (75) | CRGNB | CLSI M100-M129 | BSI, IAI, UTI, pneumonia, and others | CAZ-AVI and included at least one other antimicrobial agent administered for ≥ 72 h | 83 |
Chen 2024 | Multicenter, retrospective study | 180 (65) | CRPA | CLSI | Pneumonia, BSI, UTI, and others | Two or more drugs | 279 |
Sirijatuphat 2022 | Single-center, prospective RCT | 34 (61) | CRAB | CLSI | Pneumonia, BSI, UTI, IAI, and others | Colistin-sitafloxacin | 56 |
Kaye 2023 | Multicenter, RCT | 265 (63) | CRGNB | CLSI | Pneumonia, BSI | Colistin in combination with meropenem | 423 |
Hao 2022 | Single-center, retrospective study | 59 (24) | CRGNB | CLSI M100 | HAP, BSI, UTI, acute mentingitis | Intravenous colistin sulfate and other antimicrobial agents | 80 |
Lin 2023 | Multicenter, retrospective study | 100 (76) | CRKP | CLSI | NR | CAZ/AVI and other anti-GNB antibiotics together for more than 2Â days | 132 |
Katip 2024 | Single-center, retrospective study | 131 (60) | CRE | CLSI | UTI, pneumonia, BSI, and others | Colistin plus fosfomycin | 220 |
Zha 2023 | Single-center, retrospective study | 112 (69) | CRGNB | EUCAST | pneumonia | Tigecycline plus colistin | 162 |
Federica 2023 | Multicenter, retrospective study | 30 (75) | CRAB | EUCAST | BSI, pneumonia, UTI, IAI, bone infection, and others | Cefiderocol in combination with other (in vitro active) drugs | 38 |
Chang 2022 | Multicenter, retrospective study | 274 (75) | CRGNB | CLSI, FDA | Pneumonia | Colistin/tigecycline combined with other drugs | 364 |