Medical Journal of the Islamic Republic Of Iran

en Efficacy and Safety of Different Treatments for Acinetobacter baumannii Infection: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Meta-analysis Meta-analysis Systematic Review     Background: This Network meta-analysis (NMA) aimed to assess antimicrobial treatments for A. baumannii infections (including pneumonia, bloodstream infections, and urinary tract infections), focusing on clinical cure, microbiological eradication, mortality, and adverse events.    Methods: Following PRISMA-NMA guidelines, we searched Medline, Scopus, Web of Science, Cochrane Library, and EMBASE (2000–2024) for interventional studies on MDR-, XDR-, or PDR-A. baumannii infections. Two independent reviewers screened studies for inclusion based on predefined criteria, extracted relevant data (e.g., patient demographics, APACHE II scores, treatment regimens), and assessed study quality using the Cochrane Risk of Bias 2 (RoB 2) tool. A pairwise meta-analysis was performed using random-effects models (DerSimonian-Laird method) to calculate risk ratios (RR) with 95% confidence intervals (CI). Node-splitting analysis was performed to assess the consistency of direct and indirect evidence in the network. Statistical heterogeneity was evaluated, and consistency between direct and indirect evidence was tested.    Results: From 4,941 records, 18 studies (2,750 patients) were included in the systematic review and 16 in the NMA. No RCTs on non-antimicrobial treatments (e.g., phages, monoclonal antibodies) met the inclusion criteria, limiting the analysis to antimicrobial regimens. Colistin with rifampin (RR = 0.27, 95% CI: 0.07–0.99) and sulbactam with durlobactam (RR = 0.22, 95% CI: 0.05–0.91) significantly reduced all-cause mortality compared to colistin alone. Colistin-meropenem dual therapy improved clinical cure (RR = 0.31, 95% CI: 0.11–0.84). No regimens significantly affected microbiological eradication or adverse events. Network consistency was confirmed, with no heterogeneity detected.    Conclusion: The combination of sulbactam-durlobactam significantly reduced mortality, while colistin-rifampin also showed efficacy but requires cautious interpretation given rifampin's role as a strategic antibiotic. These findings provide valuable evidence to guide treatment decisions for these challenging infections; however, the limited number of studies for certain interventions and the absence of RCTs on non-antimicrobial therapies warrant cautious interpretation and further research.   Acinetobacter baumannii, Efficacy, Safety, Network meta-analysis, Randomized Controlled Trials 982 1011 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-1673-3&slc_lang=en&sid=1 Mohammad Aziz Rasouli rasouli1010@gmail.com 2003194753284600100997 2003194753284600100997 No Research Institute for Health Development, Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Yousef Moradi yousefmoradi211@yahoo.com 2003194753284600100998 2003194753284600100998 No Research Institute for Health Development, Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Parvin Mohammadi Parvin.m@gmail.com 2003194753284600100999 2003194753284600100999 No Department of Nursing and Midwifery, Sa.C, Islamic Azad University, Sanandaj, Iran Ghobad Moradi Moradi_gh@muk.ac.ir 2003194753284600101000 2003194753284600101000 Yes Health Metrics and Evaluation Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran