PMID- 34596881
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211117
IS  - 2193-8229 (Print)
IS  - 2193-6382 (Electronic)
IS  - 2193-6382 (Linking)
VI  - 10
IP  - 4
DP  - 2021 Dec
TI  - The Effect of Combination Therapy on Mortality and Adverse Events in Patients 
      with Staphylococcus aureus Bacteraemia: A Systematic Review and Meta-analysis of 
      Randomized Controlled Trials.
PG  - 2643-2660
LID - 10.1007/s40121-021-00539-y [doi]
AB  - INTRODUCTION: The findings of randomized controlled trials (RCTs), observational 
      studies, and meta-analyses vary regarding the effectiveness and safety of 
      combination therapy for patients with Staphylococcus aureus bacteraemia (SAB). We 
      aimed to identify the effectiveness and safety of combination therapy in patients 
      with SAB compared with those of monotherapy. METHODS: We performed a systematic 
      review and meta-analysis to compare combination therapy versus monotherapy in 
      patients with SAB. Two authors independently searched PubMed, Embase, and the 
      Cochrane Library of clinical trials until 17 February 2021. Any RCT comparing 
      mortality or adverse events (AEs) of combination therapy versus monotherapy for 
      patients with SAB was eligible. Summary risk ratios (RRs) and 95% confidence 
      intervals (CIs) were evaluated using a random-effects model. The primary outcome 
      was all-cause mortality at any time point. This meta-analysis is registered with 
      the PROSPERO database (CRD42020188176) and reported according to PRISMA 
      guidelines. RESULTS: In total, 1906 articles were identified and screened, and 14 
      studies (2367 patients) were included in the meta-analysis. There was no 
      significant difference in the risk of all-cause mortality between the two groups 
      (RR = 1.00; 95% CI 0.83-1.20; P = 0.99; I(2) = 0%). Similar results were obtained 
      by subgroup analysis of mortality recording time, endocarditis, pathogen 
      resistance, article publication time, number of patients, and adjuvant 
      antibiotics. Notably, combination treatment might significantly increase the risk 
      of drug-related AEs (RR = 1.68; 95% CI 1.06-2.66; P = 0.03; I(2) = 67%) and 
      nephrotoxicity (RR = 2.30; 95% CI 1.68-3.16; P < 0.00001; I(2) = 0%), although 
      the occurrences of AEs leading to treatment discontinuation and serious AEs were 
      not significantly different between the two groups. CONCLUSIONS: The 
      meta-analysis suggested that combination therapy could not reduce mortality but 
      might increase the risk of drug-related AEs and nephrotoxicity and should be 
      applied very cautiously. Future studies on combined drug therapy for SAB need 
      careful and rigorous design for specific antibiotic combinations.
CI  - (c) 2021. The Author(s).
FAU - Ye, Chao
AU  - Ye C
AD  - Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, People's 
      Republic of China.
FAU - Wang, Chunjiang
AU  - Wang C
AD  - Department of Pharmacy, The Third Xiangya Hospital, Central South University, 
      Changsha, Hunan, People's Republic of China.
FAU - Li, Zuojun
AU  - Li Z
AD  - Department of Pharmacy, The Third Xiangya Hospital, Central South University, 
      Changsha, Hunan, People's Republic of China.
FAU - Li, Xin
AU  - Li X
AD  - Department of Pharmacy, The Third Hospital of Changsha, Changsha, Hunan, People's 
      Republic of China.
FAU - Pan, Juan
AU  - Pan J
AD  - Department of Pharmacy, Liuyang Hospital of Traditional Chinese Medicine, 
      Changsha, Hunan, People's Republic of China.
FAU - Liu, Liang
AU  - Liu L
AD  - Neurosurgery, People's Hospital of Ningxiang City Affiliated to Hunan University 
      of Chinese Medicine, Changsha, Hunan, People's Republic of China.
FAU - Wang, Zhaohui
AU  - Wang Z
AD  - Department of Pharmacy, People's Hospital of Ningxiang City Affiliated to Hunan 
      University of Chinese Medicine, Changsha, Hunan, People's Republic of China. 
      wangzhaohuiry@163.com.
AD  - Department of Pharmacy, People's Hospital of Ningxiang City Affiliated to Hunan 
      University of Chinese Medicine, Yihuan West Road, Ningxiang City, 410600, Hunan, 
      People's Republic of China. wangzhaohuiry@163.com.
LA  - eng
GR  - 2021JJ80083/Hunan Provincial Natural Science Foundation/
PT  - Journal Article
DEP - 20211001
PL  - New Zealand
TA  - Infect Dis Ther
JT  - Infectious diseases and therapy
JID - 101634499
PMC - PMC8572899
OTO - NOTNLM
OT  - Bacteraemia
OT  - Combination therapy
OT  - Meta-analysis
OT  - Mortality
OT  - Staphylococcus aureus
EDAT- 2021/10/02 06:00
MHDA- 2021/10/02 06:01
PMCR- 2021/10/01
CRDT- 2021/10/01 12:31
PHST- 2021/08/19 00:00 [received]
PHST- 2021/09/15 00:00 [accepted]
PHST- 2021/10/02 06:00 [pubmed]
PHST- 2021/10/02 06:01 [medline]
PHST- 2021/10/01 12:31 [entrez]
PHST- 2021/10/01 00:00 [pmc-release]
AID - 10.1007/s40121-021-00539-y [pii]
AID - 539 [pii]
AID - 10.1007/s40121-021-00539-y [doi]
PST - ppublish
SO  - Infect Dis Ther. 2021 Dec;10(4):2643-2660. doi: 10.1007/s40121-021-00539-y. Epub 
      2021 Oct 1.