Monotherapy versus combination therapy for sepsis due to multidrug-resistant Acinetobacter baumannii: analysis of a multicentre prospective cohort

López-Cortés, Luis Eduardo; Cisneros, José Miguel; Fernández-Cuenca, Felipe; Bou, Germán; Tomás, María; Garnacho‐Montero, José; Pascual, Álvaro; Martínez-Martínez, Luis; Vila, Jordi; Pachón, Jerónimo; Rodríguez-Baño, Jesús; Geih,

doi:10.1093/jac/dku233

Cited by 81 publications

(69 citation statements)

References 32 publications

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“…Monotherapy was administered to 67.3% and combination therapy was administered to 32.7% of 101 patients included in the study. The study concluded no difference between [3] In our study, colistin monotherapy was used at a rate of 17.2% and combination therapies were generally preferred. Clinical response rate varied between 26.1 and 33.3% in colistin and its combinations, which is very low.…”

Section: Discussionmentioning

confidence: 51%

“…[3,14,15] Based on Gazi University Medical Faculty Hospital's Infection Control Committee data of 2002, the incidence of A. baumannii as an agent for infections in all ICUs was 27.2%, and 77% of these cases are pneumonia/VAP.…”

Section: Discussionmentioning

confidence: 99%

“…Studies comparing colistin monotherapy and combined therapies provide inconsistent results, with insufficient evidence supporting the superiority of combined therapies. [3,5,16] Colistin is usually combined with sulbactam, cephalosporins, carbapenems, piperacillintazobactam, monobactams, aminoglycosides, fluoroquinolones, rifampin, tetracyclines and tigecycline. [1,4,5,17] Two studies have achieved a positive clinical response of 73.0 -80.8% and a microbiological response of 94.9% when using colistin in the treatment of MDR Gram-negative infections.…”

Section: Discussionmentioning

confidence: 99%

“…[5] In contrast, two randomised controlled trials found no difference in mortality and cure rates despite the higher microbiological eradication rate with combined therapy, when comparing colistin and colistin-rifampicin for treating VAP and several severe infections. [3,21,22] Another study reported no clinical or statistical difference between monotherapy and combined therapy for the treatment of MDR-AB infections, and indicated that use of monotherapy would be reasonable for at least treating less severe infections. [3] The same study suggested that drug choice can be customised according to drug access, drug interactions, side-effects and costs, since there is no difference between the drugs in resistant A. baumannii pneumonia reported to be hospital acquired or ventilator associated.…”

Section: Discussionmentioning

confidence: 99%

“…[1,2] Over the last 2 decades, nosocomial infections caused by multidrug-resistant (MDR) A. baumannii (MDR-AB) have increased globally. [3] Infection by this agent increases mortality, morbidity and costs. Mortality rates can increase by up to 65% when pneumonias are caused by MDR-AB.…”

mentioning

confidence: 99%

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Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

et al. 2015

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Objective. To investigate whether there was a difference in mortality, clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU). Methods. This retrospective, observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii, on median day 5 of admission, colistin monotherapy was used in 23 (21.6%) patients, a carbapenem combination was used in 80 (59.7%) patients, sulbactam-ampicillin combination was used in 42 (31.4%) patients, tigecycline combination was used in 26 (19.4%) patients, and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days, and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii-associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%, p=0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017, 95% confidence interval (CI) 1.330 -3.061) and vasopressor use (OR 9.014, 95% CI 1.360 -59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii. Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality.S Afr J Crit Care 2015;31(2):51-58.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

et al. 2015

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Treatment of patients with serious infections due to carbapenem‐resistant Acinetobacter baumannii: How viable are the current options?

2021

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This review critically appraises the published microbiologic and clinical data on the treatment of patients with carbapenem‐resistant Acinetobacter baumannii infections. Despite being recognized as an urgent threat pathogen by the CDC and WHO, optimal treatment of patients with serious CRAB infections remains ill‐defined. Few commercially available agents exhibit reliable in vitro activity against CRAB. Historically, polymyxins have been the most active agents in vitro, though interpretations of susceptibility data are difficult given issues surrounding MIC testing methodologies and lack of correlation between MICs and clinical outcomes. Most available preclinical and clinical data involve use of polymyxins, tetracyclines, and sulbactam, alone and in combination. As the number of viable treatment options is limited, combination therapy with a polymyxin is often used for patients with CRAB infections, despite the significant risk of nephrotoxicity. However, no treatment regimen has been found to reduce mortality, which exceeds 40% across most studies, or substantially improve clinical response. While some newer agents, such as eravacycline and cefiderocol, have demonstrated in vitro activity, clinical efficacy has not been fully established. New agents with clinically relevant activity against CRAB isolates and favorable toxicity profiles are sorely needed.

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Antimicrobial Stewardship in the Intensive Care Unit

Chen

Nicolau

Kuti

2023

Antimicrobial Stewardship in Non-Traditional Settings

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Monotherapy versus combination therapy for sepsis due to multidrug-resistant Acinetobacter baumannii: analysis of a multicentre prospective cohort

Abstract: Our data do not support an association of CT with reduced mortality in MDRAB infections. More data for specific types of infection and combinations are needed.

Cited by 81 publications

References 32 publications

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

Comparison of the efficacy of colistin monotherapy and colistin combination therapies in the treatment of nosocomial pneumonia and ventilator-associated pneumonia caused by Acinetobacter baumannii

Treatment of patients with serious infections due to carbapenem‐resistant Acinetobacter baumannii: How viable are the current options?

Antimicrobial Stewardship in the Intensive Care Unit

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