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The following is a summary of “Efficacy and safety of antibiotics targeting Gram-negative bacteria in nosocomial pneumonia: a systematic review and Bayesian network meta-analysis,” published in the April 2024  issue of Critical Care by Paz et al.

Various new antibiotics are being assessed in randomized controlled trials as alternatives to existing regimens for treating nosocomial pneumonia (NP).

Researchers conducted a retrospective study to examine the effectiveness and safety of several antibiotic therapies for NP.

They systematically searched PubMed, Medline, Web of Science, EMBASE, and the Cochrane Library databases(2000 and 2021). The review focused on studies comparing antibiotic regimens targeting Gram-negative bacilli for patients with NP. All-cause mortality after 28 days was the primary outcome measure. Secondary outcomes included clinical cure, microbiological eradication, and the incidence of AEs.

The results showed 16 studies with 4,993 patients, comparing 13 antibiotic regimens. The mortality differences varied from extremely low to moderate. No noticeable difference in 28-day mortality among all beta-lactam regimens. According to the smallest trial, the combination of aerosolized colistin and meropenem significantly decreased mortality compared to intravenous colistin alone (OR = 0.43; 95% CrI [0.17–0.94]). The clinical failure rate for ceftazidime was higher than for meropenem, both with (OR = 1.97; 95% CrI [1.19–3.45]) and without aerosolized colistin (OR = 1.40; 95% CrI [1.00–2.01]), as well as compared to imipenem/cilastatin/relebactam (OR = 1.74; 95% CrI [1.03–2.90]) and ceftazidime/avibactam (OR = 1.48; 95% CrI [1.02–2.20]). No significant differences between regimens for microbiological treatment, while ceftolozane/tazobactam had the highest chance of being effective. Acute renal failure was more likely in patients receiving intravenous colistin, although there were no significant differences in the incidence of AEs between treatments, according to safety studies.

Investigator concluded that various antibiotic regimens like cefiderocol, to be effective and safe against treatable Gram-negative bacteria in nosocomial pneumonia with additional research for Gram-negative NP.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01291-5