High-dose ampicillin-sulbactam as an alternative treatment of late-onset VAP from multidrug-resistant Acinetobacter baumannii

• Published in: Scandinavian journal of infectious diseases 2007, Vol.39 (1), p.38-43
• Main Authors: Betrosian, Alex P., Frantzeskaki, Frantzeska, Xanthaki, Anna, Georgiadis, George
• Format: Article
• Language: English
• Subjects: Acinetobacter baumannii; Acinetobacter baumannii - drug effects; Acinetobacter Infections - drug therapy; Aged; Ampicillin - administration & dosage; Anti-Bacterial Agents - administration & dosage; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Bronchoalveolar Lavage Fluid - microbiology; Cross Infection; Disk Diffusion Antimicrobial Tests; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial - drug effects; Female; Humans; Intensive Care Units; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Pneumonia, Ventilator-Associated - drug therapy; Pneumonia, Ventilator-Associated - microbiology; Sulbactam - administration & dosage; Treatment Outcome
• ISSN: 0036-5548; 1651-1980
• DOI: 10.1080/00365540600951184

The increased incidence of multidrug-resistant (MDR) Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients poses a severe therapeutic problem. The aim of this study was to evaluate the efficacy and safety of 2 high-dose treatment regimens of ampicillin-sulbactam (A/S) for MDR Acinetobacter baumannii VAP. We undertook a randomized, prospective trial of critically ill patents with (MDR) Acinetobacter baumannii VAP. Patients were randomly assigned to 1 of 2 treatment regimens of A/S (at a rate 2:1 every 8 h): 1) group A, 18/9 g daily dose (n = 14); and 2) group B, 24/12 g daily dose (n = 13). The duration of therapy was 8±2 d for both groups. A total of 27 patients were enrolled in the study. Clinical improvement was seen in 66.7% of the study population in 9/14 (64.3%) of group A patients and 9/13 (69.2%) of group B patients, respectively. Bacteriological success was achieved in 77.8% of the study population (12/14, 85.7% of group A) and in 9/13 (69.2%) of group B patients. The 14-d mortality rate was 25.9% and the all cause 30-d mortality was 48.1%. Both mortality rates did not differ significantly between the 2 groups. No major adverse reactions were recorded. We concluded that clinical and bacteriological results of the study support the use of high-dose regimen of ampicillin-sulbactam for MDR Acinetobacter baumannii VAP.