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Meta-Analysis
. 2019 Oct;98(40):e17436.
doi: 10.1097/MD.0000000000017436.

Carbapenems vs tigecycline for the treatment of complicated intra-abdominal infections: A Bayesian network meta-analysis of randomized clinical trials

Lingyuan Chen  1 , Xueyan Liang  1 , Junsong Jiang  2 , Xianshu Li  1 , Yan Li  1
Affiliations
Meta-Analysis

Carbapenems vs tigecycline for the treatment of complicated intra-abdominal infections: A Bayesian network meta-analysis of randomized clinical trials

Lingyuan Chen et al. Medicine (Baltimore). 2019 Oct.

Abstract

Background: Complicated intra-abdominal infections (cIAIs) are common in clinical practice, caused by a mixture of aerobic and anaerobic bacteria, increase the risk of mortality. Carbapenems and tigecycline (TGC) are recommended for antimicrobial therapies for cIAIs.

Objective: To compare the effectiveness and safety of different carbapenems vs TGC for the treatment of cIAIs.

Methods: PubMed, Embase, Medline (via Ovid SP) and Cochrane library databases were systematically searched. We included randomized controlled trials (RCTs) comparing different carbapenems vs TGC for the treatment of cIAIs. The pooled odds ratio (OR) with 95% credible interval (CrI) was calculated by Markov chain Monte Carlo methods. We estimated summary ORs using pairwise and network meta-analysis with random effects.

Results: Fifteen studies involving 6745 participants were included in the analysis. Five different carbapenems and TGC were ultimately evaluated in this study. Although, the efficacy of carbapenems and TGC by ORs with corresponding 95% CrIs had not yet reached statistical differences, the cumulative rank probability indicated that clinical treatment success from best to worst was doripenem (DOPM), meropenem (MEPM), imipenem/cilastatin (IC), biapenem (BAPM), TGC and imipenem/cilastatin/relebactam (ICRB); microbiological treatment success from best to worst was DOPM, MEPM, IC, BAPM, ICRB and TGC. As for the risk of adverse events (AEs), TGC showed higher risk of AEs compared with IC (OR = 1.53, 95% CrI = 1.02-2.41), the remain antibiotic agents from lower to higher was MEPM, IC, BAPM, DOPM, ICRB and TGC. The risk of mortality from lower to higher was BAPM, DOPM, MEPM, IC, TGC and ICRB.

Conclusion: No differences in clinical and microbiological outcomes were observed between different carbapenems and TGC. Balancing the evidence for drug efficacy and side effects, DOPM appears to be the best available treatment for cIAIs. Therefore, it is reasonable to consider that DOPM is one of the best carbapenem monotherapy for cIAIs. MEPM and IC was also associated with higher rates of clinical and microbiological treatment success following DOPM. Empiric antimicrobial treatment of patients with cIAIs should be selected in light of the local bacterial epidemiology and patterns of resistance.

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Conflict of interest statement

The authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Selection process for the studies included in the meta-analysis.
Figure 2
Figure 2
Network plot for clinical and microbiological treatment success. (A) clinical treatment success; (B) microbiological treatment success. BAPM = biapenem, DOPM = doripenem, IC = imipenem/cilastatin, ICRB = imipenem/cilastatin/relebactam, MEPM = meropenem, TGC = tigecycline.
Figure 3
Figure 3
Forest plot from both the Bayesian network meta-analysis (open circle; CrI, credible intervals) and traditional meta-analysis (solid circle; CI, credible interval) for clinical and microbiological treatment success. (A) clinical treatment success; (B) microbiological treatment success. BAPM = biapenem; DOPM = doripenem; IC = imipenem/cilastatin; ICRB = imipenem/cilastatin/relebactam; MEPM = meropenem; TGC = tigecycline.
Figure 4
Figure 4
SUCRA and rank probability for clinical and microbiological treatment success. (A) SUCRA for clinical treatment success; (B) rank probability for clinical treatment success; (C) SUCRA for microbiological treatment success; (D) rank probability for microbiological treatment success. BAPM = biapenem, DOPM = doripenem, IC = imipenem/cilastatin, ICRB = imipenem/cilastatin/relebactam, MEPM = meropenem, SUCRA = the surface under the cumulative ranking curve, TGC = tigecycline.
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