Abstract：
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) infections pose a significant threat to global health due to limited treatment options and high mortality rates. Colistin-based regimens have emerged as a primary treatment approach, but the effectiveness and mortality outcomes of colistin monotherapy versus colistin-fosfomycin combination therapy remain uncertain. This study aims to compare the effectiveness and mortality of colistin monotherapy and colistin-fosfomycin combination therapy for CRE infections. Notably, our study is the first to undertake a comprehensive examination of the effectiveness and mortality outcomes between colistin monotherapy and colistin-fosfomycin combination therapy in the context of CRE infections.
METHODS: A retrospective cohort study was conducted using data from patients diagnosed with carbapenem-resistant Enterobacteriaceae (CRE) infections at Nakornping Hospital during 2015 to 2022. Inverse probability weighting (IPW) was employed to create balanced cohorts of patients receiving either colistin monotherapy or colistin-fosfomycin combination therapy. The primary outcome measure was treatment effectiveness, assessed by 30-day mortality. Secondary outcome measures included clinical response, mortality at the end of treatment, and microbiologic response. Univariate and multivariate logistic regression analysis were employed after applying propensity score weighting using inverse probability of weighting (IPW).
RESULTS: A total of 220 patients were included in the analysis, with 67 receiving colistin monotherapy and 153 receiving colistin-fosfomycin combination therapy. Propensity score weighting using IPW balanced the baseline characteristics between the two groups. The effectiveness of treatment, as measured by 30-day mortality, was not significantly different between the colistin monotherapy group and the colistin-fosfomycin combination therapy group (adjusted odds ratio [aOR] = 1.51, 95% confidence interval [CI]: 0.60-3.78, p = 0.383). Similarly, no significant difference was observed in the mortality at the end of treatment between the two groups (aOR = 1.26, 95% CI: 0.55-2.90, p = 0.576). The clinical response (aOR = 1.48, 95% CI: 0.61-3.59, p = 0.383) and microbiologic response (aOR = 0.66, 95% CI: 0.18-2.38, p = 0.527) were similar between the colistin monotherapy and colistin-fosfomycin combination therapy groups.
CONCLUSIONS: The propensity score analysis among 220 matched patients showed comparable treatment effectiveness and mortality between colistin monotherapy and colistin-fosfomycin combination therapy for CRE infections. These results suggest that colistin monotherapy may be as effective as combination therapy. More prospective randomized controlled trials are needed to confirm these findings and establish optimal CRE treatment strategies.
METHODS: A retrospective cohort study was conducted using data from patients diagnosed with carbapenem-resistant Enterobacteriaceae (CRE) infections at Nakornping Hospital during 2015 to 2022. Inverse probability weighting (IPW) was employed to create balanced cohorts of patients receiving either colistin monotherapy or colistin-fosfomycin combination therapy. The primary outcome measure was treatment effectiveness, assessed by 30-day mortality. Secondary outcome measures included clinical response, mortality at the end of treatment, and microbiologic response. Univariate and multivariate logistic regression analysis were employed after applying propensity score weighting using inverse probability of weighting (IPW).
RESULTS: A total of 220 patients were included in the analysis, with 67 receiving colistin monotherapy and 153 receiving colistin-fosfomycin combination therapy. Propensity score weighting using IPW balanced the baseline characteristics between the two groups. The effectiveness of treatment, as measured by 30-day mortality, was not significantly different between the colistin monotherapy group and the colistin-fosfomycin combination therapy group (adjusted odds ratio [aOR] = 1.51, 95% confidence interval [CI]: 0.60-3.78, p = 0.383). Similarly, no significant difference was observed in the mortality at the end of treatment between the two groups (aOR = 1.26, 95% CI: 0.55-2.90, p = 0.576). The clinical response (aOR = 1.48, 95% CI: 0.61-3.59, p = 0.383) and microbiologic response (aOR = 0.66, 95% CI: 0.18-2.38, p = 0.527) were similar between the colistin monotherapy and colistin-fosfomycin combination therapy groups.
CONCLUSIONS: The propensity score analysis among 220 matched patients showed comparable treatment effectiveness and mortality between colistin monotherapy and colistin-fosfomycin combination therapy for CRE infections. These results suggest that colistin monotherapy may be as effective as combination therapy. More prospective randomized controlled trials are needed to confirm these findings and establish optimal CRE treatment strategies.
摘要：
背景：由于治疗选择有限和高死亡率，耐碳青霉烯类肠杆菌（CRE）感染对全球健康构成重大威胁。基于粘菌素的方案已成为一种主要的治疗方法，但粘菌素单药治疗与粘菌素-磷霉素联合治疗的有效性和死亡率结局仍不确定.本研究旨在比较粘菌素单一疗法和粘菌素-磷霉素联合疗法治疗CRE感染的有效性和死亡率。值得注意的是,我们的研究首次对粘菌素单药治疗和粘菌素-磷霉素联合治疗在CRE感染情况下的有效性和死亡率结局进行了全面检查.
方法：采用2015年至2022年在纳克恩平医院诊断为碳青霉烯类耐药肠杆菌科（CRE）感染患者的数据进行回顾性队列研究。采用反向概率加权（IPW）来创建接受粘菌素单一疗法或粘菌素-磷霉素联合疗法的患者的平衡队列。主要结果指标是治疗有效性，以30天死亡率评估。次要结果指标包括临床反应，治疗结束时的死亡率，和微生物反应。在应用倾向评分加权后使用加权逆概率(IPW)进行单变量和多变量逻辑回归分析。
结果：共有220名患者被纳入分析，其中67人接受粘菌素单药治疗，153人接受粘菌素-磷霉素联合治疗。使用IPW的倾向评分加权平衡了两组之间的基线特征。治疗的有效性，以30天死亡率衡量，粘菌素单药治疗组和粘菌素-磷霉素联合治疗组之间无显著差异(校正比值比[aOR]=1.51,95%置信区间[CI]:0.60-3.78,p=0.383).同样，两组治疗结束时的死亡率无显著差异(aOR=1.26,95%CI:0.55~2.90,p=0.576).粘菌素单药和磷霉素联合治疗组的临床反应（aOR=1.48，95％CI：0.61-3.59，p=0.383）和微生物反应（aOR=0.66，95％CI：0.18-2.38，p=0.527）相似。
结论：对220名匹配患者的倾向评分分析显示，粘菌素单药治疗和粘菌素-磷霉素联合治疗对CRE感染的治疗效果和死亡率相当。这些结果表明粘菌素单一疗法可能与联合疗法一样有效。需要更多的前瞻性随机对照试验来证实这些发现并建立最佳的CRE治疗策略。
方法：采用2015年至2022年在纳克恩平医院诊断为碳青霉烯类耐药肠杆菌科（CRE）感染患者的数据进行回顾性队列研究。采用反向概率加权（IPW）来创建接受粘菌素单一疗法或粘菌素-磷霉素联合疗法的患者的平衡队列。主要结果指标是治疗有效性，以30天死亡率评估。次要结果指标包括临床反应，治疗结束时的死亡率，和微生物反应。在应用倾向评分加权后使用加权逆概率(IPW)进行单变量和多变量逻辑回归分析。
结果：共有220名患者被纳入分析，其中67人接受粘菌素单药治疗，153人接受粘菌素-磷霉素联合治疗。使用IPW的倾向评分加权平衡了两组之间的基线特征。治疗的有效性，以30天死亡率衡量，粘菌素单药治疗组和粘菌素-磷霉素联合治疗组之间无显著差异(校正比值比[aOR]=1.51,95%置信区间[CI]:0.60-3.78,p=0.383).同样，两组治疗结束时的死亡率无显著差异(aOR=1.26,95%CI:0.55~2.90,p=0.576).粘菌素单药和磷霉素联合治疗组的临床反应（aOR=1.48，95％CI：0.61-3.59，p=0.383）和微生物反应（aOR=0.66，95％CI：0.18-2.38，p=0.527）相似。
结论：对220名匹配患者的倾向评分分析显示，粘菌素单药治疗和粘菌素-磷霉素联合治疗对CRE感染的治疗效果和死亡率相当。这些结果表明粘菌素单一疗法可能与联合疗法一样有效。需要更多的前瞻性随机对照试验来证实这些发现并建立最佳的CRE治疗策略。
