Infect Chemother.  2021 Jun;53(2):271-283. 10.3947/ic.2021.0051.

Clinical and Microbiologic Efficacy and Safety of Imipenem/Cilastatin/ Relebactam in Complicated Infections: A Meta-analysis

• Sahra S
• Jahangir A
• Hamadi R
• Jahangir A
• Glaser A

• KMID: 2517458
• DOI: http://doi.org/10.3947/ic.2021.0051

Abstract

Background
Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for Gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (HABP), and ventilator-associated bacterial pneumonia (VABP).
Materials and Methods
We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. We included randomized clinical trials-with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A P-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I² statistic.
Results
The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups.
Conclusion
Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, HABP, VABP).

Keyword

Bacterial pneumonia; Complicated intra-abdominal infections; Complicated urinary tract infection; Imipenem; Imipenem/cilastatin/relebactam