Comparative Effectiveness of Single, Dual, and Multi-Antibiotic Therapies in Managing Carbapenem-Resistant Enterobacterales: A Systematic Review and Meta-Analysis on Survival Rates
Abstract
Carbapenem-resistant Enterobacterales (CRE) represent a major global health issue, linked to elevated rates of morbidity and mortality stemming from restricted treatment alternatives. The Gram-negative bacteria, such as Klebsiella pneumoniae and Escherichia coli, are significant contributors to severe infections, including bacteremia, pneumonia, and urinary tract infections. Mechanisms of resistance such as the production of carbapenemases, the action of efflux pumps, and mutations in porins diminish the effectiveness of carbapenems, which are frequently the antibiotics of last resort. In light of this escalating concern, the absence of a universally recognized global guideline for the management of CRE results in diverse treatment strategies. This systematic review and meta-analysis aimed to evaluate the effectiveness of monotherapy, dual therapy, and multi-antibiotic regimens in the treatment of CRE infections. In accordance with established guidelines, data from 5 major databases were analyzed, and the quality of the studies was evaluated using the Newcastle-Ottawa Scale. The findings indicated that combination therapy led to a notable enhancement in survival rates when contrasted with monotherapy (OR = 0.69, 95 % CI 0.62 - 0.78, p < 0.00001). In contrast, no significant difference was found between dual therapy and multi-antibiotic regimens (OR = 1.17, 95 % CI 0.95 - 1.46, p = 0.15). The combination therapy exhibited synergistic effects, improving bacterial eradication…
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