What question did this study set out to answer?

To determine whether combination therapy with colistin and meropenem is superior to colistin monotherapy for treating severe carbapenem-resistant bacterial infections.

December 6, 2022NEJM EvidenceOpen Access

Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms

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To determine whether combination therapy with colistin and meropenem is superior to colistin monotherapy for treating severe carbapenem-resistant bacterial infections.
Randomized superiority trial evaluating colistin monotherapy versus colistin plus meropenem combination therapy (ClinicalTrials.gov number: NCT01597973).
Enrolled patients with carbapenem-resistant infections, predominantly pneumonia (70%) and ICU-admitted individuals (69%), assessing 28-day mortality, clinical failure, and microbiologic cure.
28-day mortality did not differ significantly between colistin monotherapy and combination therapy (43% vs. 37%; P=0.17).
Clinical failure occurred in 65% of monotherapy patients versus 58% of combination patients (difference, 6.8 percentage points; 95% CI, -3.1 to 16.6), with microbiologic cure rates of 65% versus 60% (difference, 4.8 percentage points; 95% CI, -5.6 to 15.2).
Adverse event rates were similar across monotherapy and combination groups, including acute kidney injury (52% vs. 49%; P=0.55) and neurotoxicity (5% vs. 2%; P=0.29).

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Implication

Randomized trial finds no survival benefit from adding meropenem to colistin in severe carbapenem-resistant infections, indicating combination therapy offers no advantage.

Cite This Study

Kaye et al. (2022) studied this question.

synapsesocial.com/papers/6a7065163ce530166bc2d068 https://doi.org/10.1056/evidoa2200131

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Implication

Randomized trial finds no survival benefit from adding meropenem to colistin in severe carbapenem-resistant infections, indicating combination therapy offers no advantage.

Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms

Key Points

Discussion

Implication

Cite This Study

Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms

Key Points

Discussion

Implication

Cite This Study

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