Colistin alone or combined with sulbactam or carbapenem against A. baumannii in ventilator-associated pneumonia

Abstract

Introduction: Colistin use has increased over the last ten years because of multidrug-resistant microorganisms. The aim of this study was to compare the clinical and microbiological efficacy of colistin alone or in combination with sulbactam or carbapenem in the treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) and extremely drug-resistant (XDR) A. baumannii. Methodology: Cases treated for VAP because of MDR and XDR A. baumannii between January 2011 and January 2013 were included in the study. The primary and secondary outcome for colistin alone, colistin with sulbactam, and colistin with carbapenems were evaluated. The primary outcomes were clinical efficacy and microbiological efficacy; the secondary outcomes were nephrotoxicity, length of hospitalization, and mortality. Results: A total of 70 VAP patients were evaluated. A total of 17 patients (24.3%) were administered colistin alone, 20 patients (28.6%) were administered colistin and sulbactam, and 33 patients (47.1%) were administered colistin and carbapenem. Clinical and microbiological response rates were higher in the carbapenem combination group (63.6% and 63.6% in both) than in the sulbactam combination group, which registered 55.0% and 60.0%, respectively. However, this did not represent a significant difference statistically (p > 0.05). There was also no significant difference between colistin alone and the combination groups regarding clinical and microbiological efficacy and mortality. Conclusions: Neither the administration of colistin alone nor colistin combined with either sulbactam or carbapenem had any noticeable advantage in the treatment of VAP in terms of clinical response, microbiological response, nephrotoxicity, length of hospitalization, and mortality.

Intravenous polymyxins: Revival with puzzle

“…A similar conclusion was draw in XDR A. baumannii pneumonia (VAP and hospital-acquired pneumonia) by Khawcharoenporn T et al (56). But as mentioned before, Yilmaz GR et al also (31) reported that clinical and microbiological response was better in a colistincarbapenem group than a colistin-sulbactam group in VAP due to MDR or XDR A. baumannii. Mortality rates were also found to be lower in a colistin-carbapenem group, although with no statistical difference.…”

“…intravenous polymyxins alone in MDR GNB infections, most of which were pneumonias. It's indicated that the mortality ranged from 0% to 74.3% (4,21,(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), clinical response (cure and improvement) rate 7-82.1%, and microbiological eradication 27.3-73.9% (24,(33)(34)(35)(36)(37)(38). In respect to the colistin only susceptible strains, it's reported that the mortality in hospitals of intravenous colistin monotherapy was 50% (16/32) (Figure 2), 11 patients died in Intensive Care Unit (ICU) (39), and clinical cure was obtained in 82.1% of infectious episodes (23/28) and bacteriological clearance was achieved in 73.9% (17/23) of the cured infectious episodes (38).…”

“…An early retrospective study indicated that the effectiveness of colistin monotherapy did not appear to be inferior to that of colistin-meropenem combination therapy for patients with MDR bacterial infections (27). Yilmaz GR et al found that in VAP due to MDR or XDR A. baumannii, a clinical and microbiological response was better in the groups that received colistin alone and carbapenemcolistin combination when compared with the group that received sulbactam and colistin (31). Mortality rates were also found to be lower in these groups.…”

“…So CMS dosing should be adjusted in renal impaired patients according to estimated glomerular filtration rate or creatinine clearance (31,39), and polymyxin B used to be so (43). However, recent data suggest that polymyxin B does not require adjustment for renal dysfunction (78,85,86).…”

Analysis of applied empirical treatments against VAP caused by Acinetobacter baumannii

“…Zakażenia spowodowane przez A. baumannii wywołane są głównie przez szczepy wielolekooporne, co stwarza problem terapeutyczny, dlatego rezultat rekombinowanej terapii ocenia się jako wybór pozwalający na skuteczną eradykację drobnoustrojów [14,15]. W związku z tym do leczenia celowanego w OIT często stosowano antybiotykoterapię skojarzoną m.in.…”