Combination Versus Monotherapy for Carbapenem-Resistant Acinetobacter Species Serious Infections: A Prospective IPTW Adjusted Cohort Study.
Acinetobacter
CRAB infections
Combination therapy
Polymyxins
Journal
Infectious diseases and therapy
ISSN: 2193-8229
Titre abrégé: Infect Dis Ther
Pays: New Zealand
ID NLM: 101634499
Informations de publication
Date de publication:
25 Sep 2024
25 Sep 2024
Historique:
received:
12
06
2024
accepted:
02
09
2024
medline:
26
9
2024
pubmed:
26
9
2024
entrez:
25
9
2024
Statut:
aheadofprint
Résumé
International guidelines recommend definitive combination antibiotic therapy for the management of serious infections involving carbapenem-resistant Acinetobacter (CRAB) species. The commonly available combination options include high-dose sulbactam, polymyxins, tetracyclines, and cefiderocol. Scanty prospective data exist to support this approach. Patients with CRAB bacteraemia, ventilator-associated pneumonia (VAP), or both were categorized based on whether they received combination therapy or monotherapy. The 30-day mortality was compared between the two groups. Inverse probability treatment weighting (IPTW) was done using propensity score (PS) for a balanced comparison between groups. Between January 2021 and May 2023, of the 161 patients with CRAB bacteraemia (n = 55, 34.2%), VAP (n = 46, 28.6%), or both (n = 60, 37.3%) who received appropriate intravenous antibiotic therapy, 70% (112/161) received monotherapy, and the rest received combination therapy. The overall 30-day mortality was 62% (99/161) and not different (p = 0.76) between the combination therapy (31/49, 63.3%) and monotherapy (68/112, 60.7%) groups. The propensity score matching using IPTW did not show a statistical difference (p = 0.47) in 30-day mortality for receiving combination therapy with an adjusted odds ratio (OR) P of 1.29 (0.64, 2.58). Combination therapy for CRAB infections needs further study in a randomised controlled trial, as this observational study showed no difference in 30-day mortality between monotherapy and combination therapy.
Identifiants
pubmed: 39322920
doi: 10.1007/s40121-024-01042-w
pii: 10.1007/s40121-024-01042-w
doi:
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : The Wellcome Trust DBT India Alliance
ID : IA/CPHE/21/1/505972
Informations de copyright
© 2024. The Author(s).
Références
Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant gram-negative infections. Clin Infect Dis Off Publ Infect Dis Soc Am. 2023;ciad428.
Paul M, Carrara E, Retamar P, Tängdén T, Bitterman R, Bonomo RA, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine). Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2022;28(4):521–47.
McLeod SM, Moussa SH, Hackel MA, Miller AA. In vitro activity of sulbactam-durlobactam against Acinetobacter baumannii-calcoaceticus complex isolates collected globally in 2016 and 2017. Antimicrob Agents Chemother. 2020;64(4):e02534-e2619.
doi: 10.1128/AAC.02534-19
pubmed: 31988095
pmcid: 7179289
Oliveira MS, Prado GVB, Costa SF, Grinbaum RS, Levin AS. Ampicillin/sulbactam compared with polymyxins for the treatment of infections caused by carbapenem-resistant Acinetobacter spp. J Antimicrob Chemother. 2008;61(6):1369–75.
doi: 10.1093/jac/dkn128
pubmed: 18367459
Piperaki ET, Tzouvelekis LS, Miriagou V, Daikos GL. Carbapenem-resistant Acinetobacter baumannii: in pursuit of an effective treatment. Clin Microbiol Infect. 2019;25(8):951–7.
doi: 10.1016/j.cmi.2019.03.014
pubmed: 30914347
Chuang YC, Cheng CY, Sheng WH, Sun HY, Wang JT, Chen YC, et al. Effectiveness of tigecycline-based versus colistin- based therapy for treatment of pneumonia caused by multidrug-resistant Acinetobacter baumanniiin a critical setting: a matched cohort analysis. BMC Infect Dis. 2014;14(1):102.
doi: 10.1186/1471-2334-14-102
pubmed: 24564226
pmcid: 3936940
Ku K, Pogue JM, Moshos J, Bheemreddy S, Wang Y, Bhargava A, et al. Retrospective evaluation of colistin versus tigecycline for the treatment of Acinetobacter baumannii and/or carbapenem-resistant Enterobacteriaceae infections. Am J Infect Control. 2012;40(10):983–7.
doi: 10.1016/j.ajic.2011.12.014
pubmed: 22440526
Clinical & Laboratory Standards Institute [Internet]. [cited 2023 Dec 11]. M100Ed33|performance standards for antimicrobial susceptibility testing, 33rd Edition. https://clsi.org/standards/products/microbiology/documents/m100/ . Accessed 11 Dec 2023.
Durante-Mangoni E, Signoriello G, Andini R, Mattei A, De Cristoforo M, Murino P, et al. Colistin and rifampicin compared with colistin alone for the treatment of serious infections due to extensively drug-resistant Acinetobacter baumannii: a multicenter, randomized clinical trial. Clin Infect Dis Off Publ Infect Dis Soc Am. 2013;57(3):349–58.
doi: 10.1093/cid/cit253
Park HJ, Cho JH, Kim HJ, Han SH, Jeong SH, Byun MK. Colistin monotherapy versus colistin/rifampicin combination therapy in pneumonia caused by colistin-resistant Acinetobacter baumannii: a randomised controlled trial. J Glob Antimicrob Resist. 2019;17:66–71.
doi: 10.1016/j.jgar.2018.11.016
pubmed: 30476654
Aydemir H, Akduman D, Piskin N, Comert F, Horuz E, Terzi A, et al. Colistin vs. the combination of colistin and rifampicin for the treatment of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia. Epidemiol Infect. 2013;141(6):1214–22.
doi: 10.1017/S095026881200194X
pubmed: 22954403
Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial—PubMed [Internet]. [cited 2023 Dec 11]. https://pubmed.ncbi.nlm.nih.gov/29456043/ .
Colistin monotherapy versus combination therapy for carbapenem-resistant organisms|NEJM evidence [Internet]. [cited 2023 Dec 11]. https://doi.org/10.1056/EVIDoa2200131 .
Liu J, Shu Y, Zhu F, Feng B, Zhang Z, Liu L, et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: a systematic review and network meta-analysis. J Glob Antimicrob Resist. 2021;1(24):136–47.
doi: 10.1016/j.jgar.2020.08.021
Jung SY, Lee SH, Lee SY, Yang S, Noh H, Chung EK, et al. Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis. Crit Care Lond Engl. 2017;21(1):319.
doi: 10.1186/s13054-017-1916-6
Kengkla K, Kongpakwattana K, Saokaew S, Apisarnthanarak A, Chaiyakunapruk N. Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: a systematic review and network meta-analysis. J Antimicrob Chemother. 2018;73(1):22–32.
doi: 10.1093/jac/dkx368
pubmed: 29069421
Abouelhassan Y, Kuti JL, Nicolau DP, Abdelraouf K. 1652. Sulbactam against Acinetobacter baumannii pneumonia: pharmacokinetic/pharmacodynamic appraisal of current dosing recommendations. Open Forum Infect Dis. 2022;9(Supplement_2):ofac492.118.
Jaruratanasirikul S, Nitchot W, Wongpoowarak W, Samaeng M, Nawakitrangsan M. Population pharmacokinetics and Monte Carlo simulations of sulbactam to optimize dosage regimens in patients with ventilator-associated pneumonia caused by Acinetobacter baumannii. Eur J Pharm Sci Off J Eur Fed Pharm Sci. 2019;1(136): 104940.
Walker AS, White IR, Turner RM, Hsu LY, Yeo TW, White NJ, et al. Personalised randomised controlled trial designs—a new paradigm to define optimal treatments for carbapenem-resistant infections. Lancet Infect Dis. 2021;21(6):e175–81.
doi: 10.1016/S1473-3099(20)30791-X
pubmed: 33894130
pmcid: 7614698