Intravenous combined with aerosolised polymyxin versus intravenous polymyxin alone in the treatment of XXXX caused by multidrug-resistant pathogens: a systematic review and meta-analysis.

@entity1 @entity3273 @entity55
UNASSIGNED: @entity3273 has been used to treat @entity55 ( @entity55 ) caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) via different administration routes. Whether @entity1 may benefit from aerosolised @entity3273 as adjunctive treatment was contradictory. We aimed to clarify the safety and efficacy of administering aerosolised and intravenous (IV-AS) @entity3273 versus intravenous (IV) @entity3273 alone in @entity1 with @entity55 caused by MDR-GNB. Two reviewers independently evaluated and extracted data from PubMed, EMBASE and Cochrane databases. Primary outcomes were clinical response rate, all-cause mortality (ICU or hospital), microbiological eradication and nephrotoxicity. Pooled odds ratios (ORs) were calculated and significance was determined by the Z test. Nine eligible studies involving 672 @entity1 were included. The overall clinical response rate (improvement and cure) was significantly higher in the IV-AS group than that in the IV group [OR=1.81, 95% confidence interval (CI) 1.30-2.53; P=0.0005]. @entity1 treated with IV-AS @entity3273 showed a higher rate of pathogen eradication (OR=1.66, 95% CI 1.11-2.49; P=0.01) and lower all-cause mortality compared with IV @entity3273 (OR=0.69, 95% CI 0.50-0.95; P=0.02). Nephrotoxicity did not differ significantly between IV-AS and IV groups (five studies; 383 @entity1 ) (OR=1.11, 95% CI 0.69-1.80; P=0.67). These data indicate that IV-AS @entity3273 has additional benefits compared with IV @entity3273 alone. Clinicians should be encouraged to give combined administration routes in critically ill @entity1 with @entity55 caused by MDR-GNB.
