The Efficacy of Ceftazidime/Avibactam Combination Therapy vs Colistin/Polymyxin b in Critically Ill Patients: A Systematic Review and Meta-analysis
Abstract
Aims & objectives Ceftazidime/avibactam (CAZ-AVI) and Colistin/polymyxin B-based therapy are current treatment options for critically ill patients with sepsis; however, few studies have contrasted the relative efficacy of the two antibiotics regimens. This study aimed to compare the clinical efficacy and safety of CAZ-AVI therapy in combination with other antibiotics and Colistin/polymyxin-based therapy (either alone or in combination with other antibacterial drugs) in treating sepsis. Methods Electronic databases including PubMed, MEDLINE, Embase, and the Cochrane Library were searched from January 2017 to December 2024 using the following search terms: “Ceftazidime/avibactam” AND (“polymyxin B” OR “Colistimethate” OR “Colistin”) AND (“Sepsis” OR “Pneumonia” OR “VAP” OR “Bloodstream Infection”). Prospective and retrospective cohort studies comparing ICU mortality, clinical success, bacterial eradication, and adverse complications after the use of CAZ-AVI and polymyxins in critically ill patients were included. Risk ratio (RR) was used as the effect size for evaluating outcomes, using the generic inverse variance method and random model. Results Eighteen studies with 2308 patients were included (CAZ-AVI: 925, polymyxins: 1383). The pooled data showed that in patients treated with CAZ-AVI therapy had significantly lower risk of mortality [Risk ratio (RR) 0.50; 95% Confidence Interval (CI): 0.41, 0.61; I2 = 29%; p < 0.00001], better clinical improvement [RR 1.82; 95% CI: 1.45,…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,308 participants or records.
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