Outcomes in patients infected with carbapenem-resistant Acinetobacter baumannii and treated with tigecycline alone or in combination therapy

Infection ◽  
2011 ◽  
Vol 39 (6) ◽  
pp. 515-518 ◽  
Author(s):  
R. Guner ◽  
I. Hasanoglu ◽  
S. Keske ◽  
A. K. Kalem ◽  
M. A. Tasyaran
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Carbapenem Resistant

scholarly journals 135. Clinical and Microbiologic Analysis of Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S95-S96
Author(s):  
Eunbeen Cho ◽  
Hyo-Ju Son ◽  
Seongman Bae ◽  
Hyeonji Seo ◽  
Eunmi Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tract Infection ◽  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Biliary Tract ◽  
Microbiological Analysis ◽  
Biliary Tract Infection ◽  
Clinical Issue ◽  
Catheter Related Infection ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is an emerging clinical issue and shows high mortality rates. There are a few studies that have evaluated the microbiologic risk factors for mortality in CRAB bacteremia. Aim of this study is to identify the clinical and microbiologic risk factors for mortality in CRAB bacteremia. Methods Adult patients with monomicrobial CRAB bacteremia at a 2,700-bed tertiary hospital between December 2012 and December 2018 were retrospectively enrolled in the study. Risk factors for 30-day mortality were evaluated through a detailed clinical and microbiological analysis of study patients. All isolates collected on the first day of bacteremia were subjected to colistin susceptibility testing by broth microdilution and genotyping by multilocus sequence typing (MLST). Results A total of 164 patients were enrolled and 90 (55%) died within 30 days. Of the 164 patients, 111 (68%) were male and median age was 66.5 years. The most common MLST genotype was ST191 (80 isolates, 49%), followed by ST451 (14%) and ST784 (13%), and 12 (7%) isolates were resistant to colistin (MIC ≥4 mg/L). Deceased patients were more likely to have hematologic malignancy, neutropenia, pneumonia, and primary bacteremia; less likely to have solid tumor, catheter-related infection, and biliary tract infection; more likely to have a high Pitt bacteremia score; and less likely to receive appropriate antibiotic treatment, colistin, and combination therapy with colistin and tigecycline, compared with surviving patients (Table 1). Genotype, colistin MIC, and colistin resistance were not associated with mortality (Figure 1 and 2). In multivariable analysis, neutropenia (aOR, 3.25; 95% CI, 1.18–8.95), catheter-related infection (aOR, 0.33; 95% CI, 0.11–0.99), biliary tract infection (aOR, 0.20; 95% CI, 0.04–0.99), a high Pitt bacteremia score (aOR,1.42; 95% CI, 1.20–1.67), and combination therapy with colistin and tigecycline (aOR, 0.36; 95% CI, 0.14–0.92) were independent risk factors for mortality (Table 2). Conclusion Clinical factors such as the site of infection, severity of bacteremia, and specific combination therapy rather than microbiologic factors contributed to mortality in CRAB bacteremia. Appropriate combination therapy may help improving outcomes in CRAB bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals Preliminary Study of Colistin versus Colistin plus Fosfomycin for Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections

2014 ◽  
Vol 58 (9) ◽  
pp. 5598-5601 ◽  
Author(s):  
Rujipas Sirijatuphat ◽  
Visanu Thamlikitkul
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Lower Mortality ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Preliminary Study ◽  
To Receive

ABSTRACTNinety-four patients infected with carbapenem-resistantAcinetobacter baumanniiwere randomized to receive colistin alone or colistin plus fosfomycin for 7 to 14 days. The patients who received combination therapy had a significantly more favorable microbiological response and a trend toward more favorable clinical outcomes and lower mortality than those who received colistin alone. (This study has been registered at ClinicalTrials.gov under registration no. NCT01297894.)

scholarly journals Growing OXA-23 type strains among carbapenem-resistant Acinetobacter baumannii and tigecycline as an alternate combination therapy

2016 ◽  
Vol 46 ◽  
pp. 1894-1899 ◽  
Author(s):  
Şerife ALTUN ◽  
Zeliha KOÇAK TUFAN ◽  
Belgin ALTUN ◽  
Ufuk ÖNDE ◽  
Sami KINIKLI ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Carbapenem Resistant ◽  
Type Strains

scholarly journals 523. Dual vs. Triple Antibiotic Therapy for Carbapenem-Resistant Acinetobacter baumannii Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S252-S252
Author(s):  
Justin Patrick Markelwith ◽  
Nikunj M Vyas ◽  
Mark Condoluci ◽  
Sungwook Kim
Keyword(s):  
Combination Therapy ◽  
Serum Creatinine ◽  
Antibiotic Therapy ◽  
Acinetobacter Baumannii ◽  
Clinical Cure ◽  
Group Analysis ◽  
Elevated Serum ◽  
Positive Association ◽  
Primary Analysis ◽  
Carbapenem Resistant

Abstract Background Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) remain some of the most difficult to treat due to extremely high rates of resistance. The purpose of this study was to compare the efficacy of dual vs. triple targeted antibiotic regimens for CRAB infections. Methods This was an IRB approved retrospective cohort study performed at a 607-bed community health system between January 2016 and December 2018. Patients were included in the analysis if they were ≥18 years old and received antibiotics for CRAB for ≥72 hours. Patients were excluded if they were pregnant and had CRAB isolated solely from the urine. The primary endpoints of the study were differences in all-cause in-hospital mortality (ACIM) and clinical cure (CC) rates for patients treated with dual vs. triple antibiotic therapy. The secondary endpoint result focused on the difference in length of stay (LOS) between treatment groups. A sub-group analysis was performed for patients treated with tigecycline vs. minocycline combination therapy to determine differences ACIM and CC, and LOS. A multi-logistic regression analysis (MLRA) was performed to determine patient factors that were associated with ACIM and CC. Results A total of 32 patients were included in the primary analysis. No difference was seen in ACIM between dual vs. triple antibiotic groups (9.5% vs. 18.2%, P = 0.59). CC (63.6% vs. 57.1%, P = 1.0) and LOS (12 vs. 11 days, P = 1.0) was similar amongst patients treated with dual vs. triple antibiotic group. No differences were seen in ACIM (15.4% vs. 16.7% P = 1.0), CC (83.3% vs. 69.2%, P = 1.0) and LOS (15 vs. 14 days, P = 1.0) between tigecycline and minocycline combination therapy groups. The MLRA revealed a positive association with increased serum creatinine and ACIM (OR 3.29, 95% CI 1.35–8.04; P = 0.009) as well as shorter time to appropriate antibiotic therapy and clinical cure (OR 1.49, 95% CI 1.02–2.20; P = 0.04). CRAB isolates were more likely to be susceptible to minocycline vs. tigecycline (83% vs. 18%, P = 0.003). Conclusion No differences were seen in ACIM, CC and LOS between dual vs. triple antibiotic groups. Minocycline tends to sustain better susceptibility toward CRAB vs. tigecycline. Elevated serum creatinine was found to be a predictor for ACIM while shorter time to appropriate antibiotic therapy was associated with CC. Disclosures All authors: No reported disclosures.

Treatment Outcomes of Colistin- and Carbapenem-resistant Acinetobacter baumannii Infections: An Exploratory Subgroup Analysis of a Randomized Clinical Trial

2018 ◽  
Vol 69 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Yaakov Dickstein ◽  
Jonathan Lellouche ◽  
Maayan Ben Dalak Amar ◽  
David Schwartz ◽  
Amir Nutman ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Bacterial Infections ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Mortality Rates ◽  
Colistin Resistance ◽  
Randomized Controlled ◽  
Carbapenem Resistant

Abstract Background We evaluated the association between mortality and colistin resistance in Acinetobacter baumannii infections and the interaction with antibiotic therapy. Methods This is a secondary analysis of a randomized controlled trial of patients with carbapenem-resistant gram-negative bacterial infections treated with colistin or colistin-meropenem combination. We evaluated patients with infection caused by carbapenem-resistant A. baumannii (CRAB) identified as colistin susceptible (CoS) at the time of treatment and compared patients in which the isolate was confirmed as CoS with those whose isolates were retrospectively identified as colistin resistant (CoR) when tested by broth microdilution (BMD). The primary outcome was 28-day mortality. Results Data were available for 266 patients (214 CoS and 52 CoR isolates). Patients with CoR isolates had higher baseline functional capacity and lower rates of mechanical ventilation than patients with CoS isolates. All-cause 28-day mortality was 42.3% (22/52) among patients with CoR strains and 52.8% (113/214) among patients with CoS isolates (P = .174). After adjusting for variables associated with mortality, the mortality rate was lower among patients with CoR isolates (odds ratio [OR], 0.285 [95% confidence interval {CI}, .118–.686]). This difference was associated with treatment arm: Mortality rates among patients with CoR isolates were higher in those randomized to colistin-meropenem combination therapy compared to colistin monotherapy (OR, 3.065 [95% CI, 1.021–9.202]). Conclusions Colistin resistance determined by BMD was associated with lower mortality among patients with severe CRAB infections. Among patients with CoR isolates, colistin monotherapy was associated with a better outcome compared to colistin-meropenem combination therapy. Clinical Trials Registration NCT01732250

scholarly journals In VitroPharmacodynamics of Polymyxin B and Tigecycline Alone and in Combination against Carbapenem-Resistant Acinetobacter baumannii

2013 ◽  
Vol 58 (2) ◽  
pp. 874-879 ◽  
Author(s):  
Mao Hagihara ◽  
Seth T. Housman ◽  
David P. Nicolau ◽  
Joseph L. Kuti
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Population Analysis ◽  
Polymyxin B ◽  
Multidrug Resistant ◽  
Bacterial Killing ◽  
Content Type ◽  
Model Free ◽  
Carbapenem Resistant

ABSTRACTCarbapenem-resistantAcinetobacter baumanniiis increasing in prevalence. Polymyxin B and tigecycline are among the most active antibiotics used against this pathogenin vitro. Pastin vitrostudies, however, neglected the importance of simulating exposures observed in humans to determine their antibacterial effects. In this study, four carbapenem-resistantA. baumanniiisolates were evaluated using anin vitropharmacodynamic model. Free-drug exposures using 1 mg/kg of body weight of polymyxin B every 12 h (q12h), 100 and 200 mg tigecycline q12h, and the combination of these regimens were simulated. The microbiological responses to these treatments were measured by the change in log10CFU/ml over 24 h and the area under the bacterial killing and regrowth curve (AUBC). Resistance was assessed by a population analysis profile (PAP) conducted after 24 h of treatment. Polymyxin B achieved a reduction on the order of −2.05 ± 0.68 log10CFU/ml against theseA. baumanniiisolates, while all isolates grew to control levels with tigecycline monotherapy. Combination therapy with polymyxin B plus 200 mg tigecycline q12h achieved a greater reduction in bacterial density than did therapy with polymyxin B alone (−3.31 ± 0.71 versus −2.05 ± 0.68 log10CFU/ml,P< 0.001) but not significantly different than combination therapy with 100 mg tigecycline q12h (−2.45 ± 1.00 log10CFU/ml,P= 0.370). Likewise, combination therapy with polymyxin B plus 200 mg tigecycline q12h significantly reduced the AUBC compared to that with polymyxin B alone (62.8 ± 8.9 versus 79.4 ± 10.5 log10CFU/ml,P< 0.05). No changes in the PAP from baseline were observed for either antibiotic alone. In this study, combination therapy with simulated exposures of polymyxin B and tigecycline at an aggressive dose of 200 mg q12h produced synergistic or additive effects on humans against these multidrug-resistantA. baumanniistrains.

scholarly journals Clinical Outcomes and Safety of Meropenem–Colistin versus Meropenem–Tigecycline in Patients with Carbapenem-Resistant Acinetobacter baumannii Pneumonia

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 903
Author(s):  
Jaemin Park ◽  
Kyung-Sook Yang ◽  
You-Seung Chung ◽  
Ki-Byung Lee ◽  
Jeong-Yeon Kim ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Hospital Mortality ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Adult Patients ◽  
Carbapenem Resistant ◽  
Cox Proportional Hazard ◽  
Valuable Treatment ◽  
The Republic ◽  
Cox Proportional Hazard Regression

This study compared the clinical outcomes and safety of meropenem–colistin versus meropenem–tigecycline in the treatment of adult patients with carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia. A retrospective observational study of patients with CRAB pneumonia was performed at a 1048-bed university-affiliated hospital in the Republic of Korea between June 2013 and January 2020. All adult patients initially treated with meropenem–colistin were compared with those treated with meropenem–tigecycline to evaluate in-hospital mortality and adverse events. Altogether, 66 patients prescribed meropenem–colistin and 24 patients prescribed meropenem–tigecycline were included. All patients had nosocomial pneumonia, and 31.1% had ventilator-associated pneumonia. The minimum inhibitory concentrations of meropenem ≤ 8 μg/mL and tigecycline ≤ 2 μg/mL were 20.0% and 81.1%, respectively. The in-hospital and 28-day mortality rates were 40% and 32%, respectively. In the Cox proportional hazard regression analysis, predictors associated with in-hospital mortality included procalcitonin ≥ 1 ng/mL (adjusted hazard ratio (aHR), 3.39; 95% confidence interval (CI) 1.40–8.19; p = 0.007) and meropenem–colistin combination therapy (aHR, 2.58; 95% CI, 1.07–6.23; p = 0.036). Episodes of nephrotoxicity were significantly more common in the meropenem–colistin group than in the meropenem–tigecycline group (51.5% vs. 12.5%, p = 0.001). Meropenem–tigecycline combination therapy might be a valuable treatment option for patients with CRAB pneumonia.

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