TABLE 5.
Observational studies providing comparative data for monotherapy and combination therapy for different types of infection due to carbapenem-resistant Enterobacteriaceaea
| Reference | Design, no. of sites | Included infections | Carbapenemase(s) | Mortality definition | No. of deaths/no. of patients treated with MT (%) | No. of deaths/no. of patients treated with CT (%) | CT protective or not; adjusted OR (95% CI) for mortality with CTb |
|---|---|---|---|---|---|---|---|
| 213 | Prospective, 9 sites (Italy) | Infections due to ERTr K. pneumoniae | Mostly KPC | In-hospital | 8/37 (21.6) | 17/54 (31.4) | CT not protective (OR not provided) |
| 215 | Retrospective, 3 sites (Brazil) | Infections due to KPC-producing K. pneumoniae | KPC | 30-day | 21/57 (36.8) | 32/61 (52.4) | CT not protective (OR not provided) |
| 227 | Retrospective, 5 sites (Italy)c | Infections due to KPC-producing K. pneumoniae | KPC | 30-day | 118/307 (38.4) | 107/354 (30.2) | CT protective; 0.52 (0.35–0.77) |
| 230 | Retrospective, 17 sites (Taiwan) | ICU infections due to CR K. pneumoniae/E. coli | Mostly AmpC/ESBL plus porin loss | 30-day | 7/23 (30.4) | 5/10 (50) | CT not protective (OR not provided) |
| 231 | Prospective, 1 site (Brazil) | Infections due to CRE | Mostly KPC | Infection related | 6/29 (20.6); for UTI, 6/28 (21.4) | 38/78 (38.7); for UTI, 6/23 (26) | CT not protective (OR not provided) |
| 232 | Retrospective, 1 site (Colombia) | Children, CR K. pneumoniae infections | Not studied | Not specified | 2/19 (10.5) | 9/22 (40.9) | MV analysis not performed |
| 233 | Retrospective, 1 site (Brazil) | HAI due to KPC-producing K. pneumoniae, cancer patients | KPC | 30-day | 8/22 (36.6) | 21/38 (55.2) | CT not protective (OR not provided) |
| 234 | Prospective, 1 site (Greece) | CR K. pneumoniae infections, ICU | KPC | Infection related | Not specified | Not specified | CT not protective (OR not provided) |
| 235 | Retrospective, 1 site (South Africa) | Infections due to OXA-48 producers | OXA-48 | In-hospital | 2/6 (33.3) | 5/13 (38.4) | MV analysis not performed |
| 236 | 2 sites (Brazil) | VAP due to CRE | Not specified | 30-day | 40/66 (60.6) | 6/17 (35.2) | CT not protective (OR not provided) |
a
Superiority of specific combinations or drugs in monotherapy cannot be discarded. MT, monotherapy; CT, combination therapy; OR, odds ratio; CI, confidence interval; ERTr, ertapenem resistant; CR, carbapenem resistant; ESBL, extended-spectrum β-lactamase; CRE, carbapenem-resistant Enterobacteriaceae; UTI, urinary tract infection; MV, multivariable; ICU, intensive care unit; VAP, ventilator-associated pneumonia; HAI, health care-associated infections.
b
When the adjusted OR was provided for MT, the inverse was calculated.
c
Includes patients from reference 225.