Cefoperazone/Sulbactam Combined With Different Antibiotics In The Treatment Of Resistant Acinetobacter Baumannii Pneumonia:an Updated Meta-analysis

Objective:To compare the therapeutic efficacy of cefoperazone/sulbactam(C/S)combined with tigecycline or other antibacterial drugs on pneumonia caused by multiple-drug/pan-resistant Acinetobacter baumannii(AB)in China via meta-analysis.Methods:Related articles published from May 2013 to may 2019 were searched in the WanFang,SinoMed,CNKI,VIP,PubMed and Web of Science databases.Data were extracted and analyzed using Stata9.2 software.Results:Twenty-two eligible articles involving 1,481 pneumonia patients were included in the analysis.Compared with other combined antibacterial drugs,C/S+tigecycline remarkably improved the clinical response rate(odds ratio [OR]=1.31,95% confidence interval [95%CI]=1.017–1.542)and microbial clearance rate(OR=1.39,95%CI=1.170–1.656)in HAP induced by multi-drug/pan-resistant AB.No significant difference in adverse event incidence was identified between the two strategies(OR=1.05,95%CI=0.598–1.826).Subgroup analysis uncovered significant differences only in clinical response rate(OR=1.42,95%CI=1.124–1.784)and microbial clearance rate(OR=1.61,95%CI=1.210–2.138)for C/S combined with carbapenems,no significant difference in adverse event incidence was identified(OR=1.63,95%CI 0.648~4.120).Compared with C/S combined with minocycline group,the clinical response rate(OR=1.18,95%CI=0.880–1.589),microbial clearance rate(OR=1.25,95%CI=0.937–1.662)were not statistically different;compared with other groups,the clinical response rate(OR=1.23,95%CI=0.820–1.844),microbial clearance rate(OR=1.32,95%CI=0.935–1.853),adverse event incidence(OR=0.79,95%CI=0.386–1.622)There was no statistical difference.Conclusion:In China,the therapeutic efficacy of C/S+tigecycline was better than that of C/S combined with carbapenems for treating drug-resistant AB-induced pneumonia.Nevertheless,the therapeutic efficacy of C/S+tigecycline was similar to that of C/S combined with minocycline.This combination may be the most cost-effective for treating drug-resistant AB-induced pneumonia.