(1) Introduction: Colistin combination therapy with other antibiotics is a way to enhance colistin activity. The purpose of this meta-analysis was to compare the efficacy and safety of treatment with colistin monotherapy versus colistin plus meropenem combination therapy in patients with drug-resistant Acinetobacter baumannii infection. (2) Methods: All studies were included if they reported one or more of the following outcomes: clinical improvement, complete microbiological response, 14-day mortality, hospital mortality, or nephrotoxicity. (3) Results: Three randomized controlled trials and seven retrospective studies were included in the meta-analysis. Colistin monotherapy has similar rates of clinical improvement, 14-day mortality, hospital mortality, and nephrotoxicity as colistin plus meropenem combination therapy. Regarding complete microbiological response, the colistin plus meropenem combination was better than colistin monotherapy. (4) Discussion: Previous meta-analyses demonstrated heterogeneity in study quality and a lack of evidence supporting the use of colistin-based combination therapy. Our meta-analysis clearly showed that colistin combined with meropenem was not superior to colistin monotherapy for the treatment of Acinetobacter baumannii infection. (5) Conclusions: The efficacy and safety of treatment with colistin monotherapy and that of colistin plus meropenem combination therapy in patients with drug-resistant Acinetobacter baumannii infection were comparable. The majority of the evidence was obtained from nonrandomized studies, and high-quality randomized controlled trials are needed to confirm the role of colistin plus meropenem combination therapy in the treatment of multidrug-resistant Acinetobacter baumannii infection.

Background and Objectives: The therapeutic management of Fournier’s gangrene involves the use of broad-spectrum antibiotics and adequate surgical debridement; however, the overall mortality rate remains high globally. Hyperbaric oxygen therapy may serve as an adjunct treatment modality for reducing mortality in patients with Fournier’s gangrene, but its efficacy remains debatable. Consequently, this meta-analysis assessed the effect of hyperbaric oxygen therapy on mortality in patients with Fournier’s gangrene. Materials and Methods: To assess the effect of hyperbaric oxygen therapy on patients with Fournier’s gangrene, various databases were meticulously searched by focusing on the study population, intervention, control, and mortality outcomes. Results: Fourteen studies, enrolling a total of 793 patients, including 356 in the hyperbaric oxygen therapy cohort and 437 in the nonhyperbaric oxygen therapy cohort, were included in this meta-analysis. Compared with the mortality rate of 27.45% in the control cohort, the rate in the hyperbaric oxygen therapy cohort was 9.55%. This difference between patients with Fournier’s gangrene who underwent conventional therapy with hyperbaric oxygen therapy and those receiving only conventional therapy was significant (RR = 0.33; 95% CI 0.23–0.48; p < 0.001). Conclusions: Hyperbaric oxygen therapy may serve as an adjunct intervention to mitigate the increased risk of mortality among patients with Fournier’s gangrene. Methodologically rigorous randomized controlled trials must be conducted to determine the appropriate dosage and therapeutic efficacy of hyperbaric oxygen therapy in these patients and identify specific patient cohorts poised to obtain a benefit from this treatment.

This is an Author Reply to the Letter to the Editor entitled “Colistin Monotherapy versus Colistin plus Meropenem Combination Therapy for the Treatment of Multidrug-Resistant Acinetobacter baumannii Infection: A Meta-Analysis” by Daitch V. et al.