Effect of antibiotic regimens for bloodstream infections caused by KPC-producing enterobacter: a network...

This study aimed to assess the impact of different antibiotic regimens on bloodstream infections (BSIs) caused by Klebsiella pneumoniae producing Klebsiella pneumoniae carbapenemase (KPC).

A thorough literature search was performed using Web of Science, Embase, PubMed, and the Cochrane Library, which yielded 16 studies on antibiotic regimens for KPC-Ent BSI for network meta-analysis (NMA). We calculated pooled overall mortality rates along with 95% confidence intervals (CIs) and utilized the surface under the cumulative ranking curves (SUCRA) to evaluate the efficacy of antibiotic regimens.

Nineteen studies involving 10 treatment regimens were included in the network meta-analysis. For overall mortality, meropenem monotherapy (MEM_Mono) ranked highest, with the greatest probability of being the best treatment (SUCRA 84.0%; PrBest 64.0%). In the subgroup analysis, amikacin monotherapy (AMG_Mono) showed the highest ranking for 28-day mortality (SUCRA 91.3%), whereas MEM_Mono remained the top-ranked regimen for 30-day mortality (SUCRA 83.2%). The consistency and sensitivity analyses supported the robustness of the findings.

Overall, the evidence suggests that MEM_Mono may be the most favorable regimen for KPC-Ent BSI, while the optimal treatment may vary according to the mortality assessment timepoint.