Effect of Aminoglycoside and β-Lactam Combination Therapy versus β-Lactam Monotherapy on the Emergence of Antimicrobial Resistance: A Meta-analysis of Randomized, Controlled Trials
Background. The addition of an aminoglycoside to a β-lactam therapy regimen has been suggested to have a beneficial effect in delaying or preventing the development of antimicrobial resistance. We studied the effect of aminoglycoside/β-lactam combination therapy versus β-lactam monotherapy on the em...
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| Veröffentlicht in: | Clinical infectious diseases 2005-07, Vol.41 (2), p.149-158 |
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| creator | Bliziotis, Ioannis A. Samonis, George Vardakas, Konstantinos Z. Chrysanthopoulou, Stavroula Falagas, Matthew E. |
| description | Background. The addition of an aminoglycoside to a β-lactam therapy regimen has been suggested to have a beneficial effect in delaying or preventing the development of antimicrobial resistance. We studied the effect of aminoglycoside/β-lactam combination therapy versus β-lactam monotherapy on the emergence of resistance. Methods. We performed a meta-analysis of randomized, controlled trials (RCTs) that compared aminoglycoside/β-lactam combination therapy with β-lactam monotherapy and that reported data regarding the emergence of resistance (primary outcome) and/or development of superinfection, treatment failure, treatment failure attributable to emergence of resistance, treatment failure attributable to superinfection, all-cause mortality during treatment, and mortality due to infection. Data for this meta-analysis were identified from the PubMed database, Current Contents database, Cochrane central register of controlled trials, and references in relevant articles. Results. A total of 8 RCTs were included in the analysis. β-Lactam monotherapy was not associated with a greater emergence of resistance than was the aminoglycoside/β-lactam combination (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56–1.47). Actually, β-lactam monotherapy was associated with fewer superinfections (OR, 0.62; 95% CI, 0.42–0.93) and fewer treatment failures (OR, 0.62; 95% CI, 0.38–1.01). Rates of treatment failure attributable to emergence of resistance (OR, 3.09; 95% CI, 0.75–12.82), treatment failure attributable to superinfection (OR, 0.60; 95% CI, 0.33–1.10), all-cause mortality during treatment (OR, 0.70; 95% CI, 0.40–1.25), and mortality due to infection (OR, 0.74; 95% CI, 0.46–1.21) did not differ significantly between the 2 regimens. Conclusions. Compared with β-lactam monotherapy, the aminoglycoside/β-lactam combination was not associated with a beneficial effect on the development of antimicrobial resistance among initially antimicrobial-susceptible isolates. |
| doi_str_mv | 10.1086/430912 |
| format | Article |
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The addition of an aminoglycoside to a β-lactam therapy regimen has been suggested to have a beneficial effect in delaying or preventing the development of antimicrobial resistance. We studied the effect of aminoglycoside/β-lactam combination therapy versus β-lactam monotherapy on the emergence of resistance. Methods. We performed a meta-analysis of randomized, controlled trials (RCTs) that compared aminoglycoside/β-lactam combination therapy with β-lactam monotherapy and that reported data regarding the emergence of resistance (primary outcome) and/or development of superinfection, treatment failure, treatment failure attributable to emergence of resistance, treatment failure attributable to superinfection, all-cause mortality during treatment, and mortality due to infection. Data for this meta-analysis were identified from the PubMed database, Current Contents database, Cochrane central register of controlled trials, and references in relevant articles. Results. A total of 8 RCTs were included in the analysis. β-Lactam monotherapy was not associated with a greater emergence of resistance than was the aminoglycoside/β-lactam combination (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56–1.47). Actually, β-lactam monotherapy was associated with fewer superinfections (OR, 0.62; 95% CI, 0.42–0.93) and fewer treatment failures (OR, 0.62; 95% CI, 0.38–1.01). Rates of treatment failure attributable to emergence of resistance (OR, 3.09; 95% CI, 0.75–12.82), treatment failure attributable to superinfection (OR, 0.60; 95% CI, 0.33–1.10), all-cause mortality during treatment (OR, 0.70; 95% CI, 0.40–1.25), and mortality due to infection (OR, 0.74; 95% CI, 0.46–1.21) did not differ significantly between the 2 regimens. Conclusions. Compared with β-lactam monotherapy, the aminoglycoside/β-lactam combination was not associated with a beneficial effect on the development of antimicrobial resistance among initially antimicrobial-susceptible isolates.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/430912</identifier><identifier>PMID: 15983909</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Aminoglycosides ; Aminoglycosides - administration & dosage ; Aminoglycosides - pharmacology ; Anti-Bacterial Agents - administration & dosage ; Anti-Bacterial Agents - pharmacology ; Antibacterial agents ; Antibiotic resistance ; Antibiotics ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antimicrobials ; Bacterial Infections - drug therapy ; Bacterial Infections - mortality ; beta-Lactams - administration & dosage ; beta-Lactams - pharmacology ; Biological and medical sciences ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Experimentation ; Humans ; Infections ; Major Articles ; Medical sciences ; Medical treatment failures ; Mortality ; Odds Ratio ; Pharmacology. Drug treatments ; Randomized controlled trials ; Randomized Controlled Trials as Topic ; Superinfection ; Treatment Failure</subject><ispartof>Clinical infectious diseases, 2005-07, Vol.41 (2), p.149-158</ispartof><rights>Copyright 2005 The Infectious Diseases Society of America</rights><rights>2005 by the Infectious Diseases Society of America 2005</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c424t-8f455966395f49ed8c1510c6493503a9365d6efd93ff390daf4a13008e1e6c223</citedby><cites>FETCH-LOGICAL-c424t-8f455966395f49ed8c1510c6493503a9365d6efd93ff390daf4a13008e1e6c223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/4463337$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/4463337$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,777,781,800,27905,27906,57998,58231</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17012169$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15983909$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bliziotis, Ioannis A.</creatorcontrib><creatorcontrib>Samonis, George</creatorcontrib><creatorcontrib>Vardakas, Konstantinos Z.</creatorcontrib><creatorcontrib>Chrysanthopoulou, Stavroula</creatorcontrib><creatorcontrib>Falagas, Matthew E.</creatorcontrib><title>Effect of Aminoglycoside and β-Lactam Combination Therapy versus β-Lactam Monotherapy on the Emergence of Antimicrobial Resistance: A Meta-analysis of Randomized, Controlled Trials</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. The addition of an aminoglycoside to a β-lactam therapy regimen has been suggested to have a beneficial effect in delaying or preventing the development of antimicrobial resistance. We studied the effect of aminoglycoside/β-lactam combination therapy versus β-lactam monotherapy on the emergence of resistance. Methods. We performed a meta-analysis of randomized, controlled trials (RCTs) that compared aminoglycoside/β-lactam combination therapy with β-lactam monotherapy and that reported data regarding the emergence of resistance (primary outcome) and/or development of superinfection, treatment failure, treatment failure attributable to emergence of resistance, treatment failure attributable to superinfection, all-cause mortality during treatment, and mortality due to infection. Data for this meta-analysis were identified from the PubMed database, Current Contents database, Cochrane central register of controlled trials, and references in relevant articles. Results. A total of 8 RCTs were included in the analysis. β-Lactam monotherapy was not associated with a greater emergence of resistance than was the aminoglycoside/β-lactam combination (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56–1.47). Actually, β-lactam monotherapy was associated with fewer superinfections (OR, 0.62; 95% CI, 0.42–0.93) and fewer treatment failures (OR, 0.62; 95% CI, 0.38–1.01). Rates of treatment failure attributable to emergence of resistance (OR, 3.09; 95% CI, 0.75–12.82), treatment failure attributable to superinfection (OR, 0.60; 95% CI, 0.33–1.10), all-cause mortality during treatment (OR, 0.70; 95% CI, 0.40–1.25), and mortality due to infection (OR, 0.74; 95% CI, 0.46–1.21) did not differ significantly between the 2 regimens. Conclusions. Compared with β-lactam monotherapy, the aminoglycoside/β-lactam combination was not associated with a beneficial effect on the development of antimicrobial resistance among initially antimicrobial-susceptible isolates.</description><subject>Aminoglycosides</subject><subject>Aminoglycosides - administration & dosage</subject><subject>Aminoglycosides - pharmacology</subject><subject>Anti-Bacterial Agents - administration & dosage</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Antibacterial agents</subject><subject>Antibiotic resistance</subject><subject>Antibiotics</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antimicrobials</subject><subject>Bacterial Infections - drug therapy</subject><subject>Bacterial Infections - mortality</subject><subject>beta-Lactams - administration & dosage</subject><subject>beta-Lactams - pharmacology</subject><subject>Biological and medical sciences</subject><subject>Drug Resistance, Bacterial</subject><subject>Drug Therapy, Combination</subject><subject>Experimentation</subject><subject>Humans</subject><subject>Infections</subject><subject>Major Articles</subject><subject>Medical sciences</subject><subject>Medical treatment failures</subject><subject>Mortality</subject><subject>Odds Ratio</subject><subject>Pharmacology. Drug treatments</subject><subject>Randomized controlled trials</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Superinfection</subject><subject>Treatment Failure</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctu1DAUhiMEoqXAEyBkFrAiYI8vsbsbDQNFTEGqBqliE3mc4-KSxIPtIIbHYsFj8Ex4SNRhw-oc-f98bn9RPCT4BcFSvGQUKzK7VRwTTqtScEVu5xxzWTJJ5VFxL8ZrjAmRmN8tjghXkiqsjotfS2vBJOQtmneu91ftzvjoGkC6b9Dvn-VKm6Q7tPDdxvU6Od-j9WcIertD3yDEIf4Dnfvep0nMXE7RsoNwBb2Bvx365Dpngt843aILiC4mnbVTNEfnkHSpe93u8usevsgD-M79gOZ57t6n4NsWGrQO-W-8X9yxOcCDKZ4UH18v14uzcvXhzdvFfFUaNmOplJZxroSgilumoJGGcIKNYIpyTLWigjcCbKOotfkejbZME4qxBALCzGb0pHg21t0G_3WAmOrORQNtq3vwQ6xFpSqab3kA83YxBrD1NrhOh11NcL13qB4dyuDjqeKw6aA5YJMlGXg6AToa3dqQL-TigaswmRGx556MnB-2_2_2aGSuY_LhhmJMUEqrLJejnH2A7zeyDl_yYrTi9dnlp3p9Kd6v3r2SNaF_AEO9vdE</recordid><startdate>20050715</startdate><enddate>20050715</enddate><creator>Bliziotis, Ioannis A.</creator><creator>Samonis, George</creator><creator>Vardakas, Konstantinos Z.</creator><creator>Chrysanthopoulou, Stavroula</creator><creator>Falagas, Matthew E.</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20050715</creationdate><title>Effect of Aminoglycoside and β-Lactam Combination Therapy versus β-Lactam Monotherapy on the Emergence of Antimicrobial Resistance: A Meta-analysis of Randomized, Controlled Trials</title><author>Bliziotis, Ioannis A. ; Samonis, George ; Vardakas, Konstantinos Z. ; Chrysanthopoulou, Stavroula ; Falagas, Matthew E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c424t-8f455966395f49ed8c1510c6493503a9365d6efd93ff390daf4a13008e1e6c223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Aminoglycosides</topic><topic>Aminoglycosides - administration & dosage</topic><topic>Aminoglycosides - pharmacology</topic><topic>Anti-Bacterial Agents - administration & dosage</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Antibacterial agents</topic><topic>Antibiotic resistance</topic><topic>Antibiotics</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antimicrobials</topic><topic>Bacterial Infections - drug therapy</topic><topic>Bacterial Infections - mortality</topic><topic>beta-Lactams - administration & dosage</topic><topic>beta-Lactams - pharmacology</topic><topic>Biological and medical sciences</topic><topic>Drug Resistance, Bacterial</topic><topic>Drug Therapy, Combination</topic><topic>Experimentation</topic><topic>Humans</topic><topic>Infections</topic><topic>Major Articles</topic><topic>Medical sciences</topic><topic>Medical treatment failures</topic><topic>Mortality</topic><topic>Odds Ratio</topic><topic>Pharmacology. Drug treatments</topic><topic>Randomized controlled trials</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Superinfection</topic><topic>Treatment Failure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bliziotis, Ioannis A.</creatorcontrib><creatorcontrib>Samonis, George</creatorcontrib><creatorcontrib>Vardakas, Konstantinos Z.</creatorcontrib><creatorcontrib>Chrysanthopoulou, Stavroula</creatorcontrib><creatorcontrib>Falagas, Matthew E.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bliziotis, Ioannis A.</au><au>Samonis, George</au><au>Vardakas, Konstantinos Z.</au><au>Chrysanthopoulou, Stavroula</au><au>Falagas, Matthew E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Aminoglycoside and β-Lactam Combination Therapy versus β-Lactam Monotherapy on the Emergence of Antimicrobial Resistance: A Meta-analysis of Randomized, Controlled Trials</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2005-07-15</date><risdate>2005</risdate><volume>41</volume><issue>2</issue><spage>149</spage><epage>158</epage><pages>149-158</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. The addition of an aminoglycoside to a β-lactam therapy regimen has been suggested to have a beneficial effect in delaying or preventing the development of antimicrobial resistance. We studied the effect of aminoglycoside/β-lactam combination therapy versus β-lactam monotherapy on the emergence of resistance. Methods. We performed a meta-analysis of randomized, controlled trials (RCTs) that compared aminoglycoside/β-lactam combination therapy with β-lactam monotherapy and that reported data regarding the emergence of resistance (primary outcome) and/or development of superinfection, treatment failure, treatment failure attributable to emergence of resistance, treatment failure attributable to superinfection, all-cause mortality during treatment, and mortality due to infection. Data for this meta-analysis were identified from the PubMed database, Current Contents database, Cochrane central register of controlled trials, and references in relevant articles. Results. A total of 8 RCTs were included in the analysis. β-Lactam monotherapy was not associated with a greater emergence of resistance than was the aminoglycoside/β-lactam combination (odds ratio [OR], 0.90; 95% confidence interval [CI], 0.56–1.47). Actually, β-lactam monotherapy was associated with fewer superinfections (OR, 0.62; 95% CI, 0.42–0.93) and fewer treatment failures (OR, 0.62; 95% CI, 0.38–1.01). Rates of treatment failure attributable to emergence of resistance (OR, 3.09; 95% CI, 0.75–12.82), treatment failure attributable to superinfection (OR, 0.60; 95% CI, 0.33–1.10), all-cause mortality during treatment (OR, 0.70; 95% CI, 0.40–1.25), and mortality due to infection (OR, 0.74; 95% CI, 0.46–1.21) did not differ significantly between the 2 regimens. Conclusions. Compared with β-lactam monotherapy, the aminoglycoside/β-lactam combination was not associated with a beneficial effect on the development of antimicrobial resistance among initially antimicrobial-susceptible isolates.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>15983909</pmid><doi>10.1086/430912</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aminoglycosides Aminoglycosides - administration & dosage Aminoglycosides - pharmacology Anti-Bacterial Agents - administration & dosage Anti-Bacterial Agents - pharmacology Antibacterial agents Antibiotic resistance Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents Antimicrobials Bacterial Infections - drug therapy Bacterial Infections - mortality beta-Lactams - administration & dosage beta-Lactams - pharmacology Biological and medical sciences Drug Resistance, Bacterial Drug Therapy, Combination Experimentation Humans Infections Major Articles Medical sciences Medical treatment failures Mortality Odds Ratio Pharmacology. Drug treatments Randomized controlled trials Randomized Controlled Trials as Topic Superinfection Treatment Failure |
| title | Effect of Aminoglycoside and β-Lactam Combination Therapy versus β-Lactam Monotherapy on the Emergence of Antimicrobial Resistance: A Meta-analysis of Randomized, Controlled Trials |
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