In this systematic review and meta-analysis, the authors searched a total of 29 studies with 2529 patients (median age 60 years; 65% male; median APACHE II score 19.0). Although there were no statistically significant differences between treatment options, triple therapy with colistin, sulbactam and tigecycline had the highest clinical cure rate. Colistin in combination with sulbactam was associated with a significantly higher microbiological cure rate compared with colistin in combination with tigecycline (RR 1.23; 95% CI 1.03–1.47) and colistin monotherapy (RR 1.21; 95% CI 1.06–1.38). No significant differences in all-cause mortality were noted between treatment options. Tigecycline-based therapy also appeared less effective for achieving a microbiological cure and is not appropriate for treating bloodstream MDR- and XDR-AB infections.
The authors conclude that combination therapy of colistin with sulbactam demonstrates superiority in terms of microbiological cure with a safety profile similar to that of colistin monotherapy. However a mortality difference could not be demonstrated for combination therapy.