Antibiotic strategies and clinical outcomes in critically ill patients with pneumonia caused by carbapenem-resistant Acinetobacter baumannii

C-A Liang; Y-C Lin; P-L Lu; H-C Chen; H-L Chang; C-C Sheu

doi:10.1016/j.cmi.2017.10.033

Antibiotic strategies and clinical outcomes in critically ill patients with pneumonia caused by carbapenem-resistant Acinetobacter baumannii

Clin Microbiol Infect. 2018 Aug;24(8):908.e1-908.e7. doi: 10.1016/j.cmi.2017.10.033. Epub 2017 Nov 3.

Authors

C-A Liang¹, Y-C Lin², P-L Lu³, H-C Chen⁴, H-L Chang⁵, C-C Sheu⁶

Affiliations

¹ Master Program of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
² School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; Ph.D. Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan.
⁵ Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.
⁶ Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: sheucc@gmail.com.

PMID: 29108947
DOI: 10.1016/j.cmi.2017.10.033

Abstract

Objectives: This study aimed to investigate antibiotic prescribing patterns and effectiveness of different anti-carbapenem-resistant Acinetobacter baumannii (CRAB) strategies for CRAB pneumonia.

Methods: We conducted a multicentre, retrospective study in three hospitals. During 2010-2015, adult ICU patients with CRAB pneumonia treated with at least one antimicrobial agent covering the CRAB isolate in vitro for more than 2 days were included. We used multivariate logistic regression to analyse the associations of anti-CRAB strategies with ICU mortality and other clinical outcomes.

Results: Among 238 patients with CRAB pneumonia, tigecycline monotherapy (84, 35.3%) was the most common antibiotic strategy, followed by tigecycline with colistin (43, 18.1%), colistin monotherapy (34, 14.3%), colistin combination without tigecycline (33, 13.9%), tigecycline combination without colistin (32, 13.4%), and sulbactam-based therapy without tigecycline and colistin (12, 5.0%). In multivariate analysis, tigecycline-based therapy was associated with higher ICU mortality than non-tigecycline therapy (adjusted OR 2.30, 95% CI 1.19-4.46). There was no difference between colistin-based therapy and non-colistin therapy. Compared with tigecycline monotherapy, colistin monotherapy was associated with lower ICU mortality (aOR 0.30, 95% CI 0.10-0.88). Treatment failure analyses showed similar trends. Tigecycline-based therapy was associated with higher treatment failure rate than non-tigecycline therapy (aOR 2.51, 95% CI 1.39-4.54), whereas colistin-based therapy was associated with lower treatment failure rate than non-colistin-based therapy (aOR 0.48, 95% CI 0.27-0.86).

Conclusions: Tigecycline was commonly prescribed for CRAB pneumonia. However, tigecycline-based therapy was associated with higher ICU mortality and treatment failure. Our study suggests that colistin monotherapy may be a better antibiotic strategy for CRAB pneumonia.

Keywords: Antimicrobial agents; Carbapenem-resistant Acinetobacter baumannii; Intensive care unit; Mortality; Pneumonia.

Publication types

Multicenter Study

MeSH terms

Acinetobacter Infections / diagnosis
Acinetobacter Infections / drug therapy*
Acinetobacter Infections / epidemiology
Acinetobacter Infections / microbiology*
Acinetobacter baumannii / drug effects*
Acinetobacter baumannii / genetics
Aged
Aged, 80 and over
Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use*
Antimicrobial Stewardship
Carbapenems / pharmacology
Carbapenems / therapeutic use*
Coinfection
Critical Illness*
Drug Therapy, Combination
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Microbial Sensitivity Tests
Middle Aged
Retrospective Studies
Severity of Illness Index
Taiwan / epidemiology
Treatment Failure
Treatment Outcome
beta-Lactam Resistance*

Substances

Anti-Bacterial Agents
Carbapenems