Efficacy of monotherapy or combination therapy against bloodstream infection caused by carbapenem-resistant Klebsiella pneumoniae

Objectives: The aim of this study was to summarize available dataon monotherapy or combination therapy for bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods: A systematic review and meta-analysis was conducted to compare monotherapy with combination therapy in patients with BSI-CRKP. Mortality was the primary outcome. Results: A total of 1675 patients in 13 studies were included. The pooled risk ratio (RR) of mortality were 0.79 (95%CI: 0.60-1.05) between combination therapy and monotherapy. However, no significant difference in mortality was observed. The RR of polymyxins-based and tigecycline-based combination therapy were 0.72 (95%CI: 0.47-1.12) and 0.67 (95%CI: 0.42-1.09), respectively. Similarly, the difference is statistically insignificant. Further analysis showed the lower mortality associated with polymyxins+tigecycline-based combination therapies than that with tigecycline combined with other antibiotics (RR=0.66, 95%CI: 0.52-0.83, P=0.00). Conclusions: Combination therapy against BSI-CRKP has survival benefit, especially for polymyxins+tigecycline-containing therapies.