Colistin versus colistin combined with ampicillin-sulbactam for multiresistant Acinetobacter baumannii ventilator-associated pneumonia treatment: An open-label prospective study

Background: Retrospective studies have reported good clinical success rates using colistin as monotherapy to treat Acinetobacter baumannii ventilator-associated pneumonia (VAP), comparable to that obtained with colistin combined with other antibiotics. However, inadequate penetration into the pulmon...

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Published in:Indian journal of critical care medicine 2018-02, Vol.22 (2), p.67-77
Main Authors: Makris, Demosthenes, Petinaki, Efi, Tsolaki, Vasssiliki, Manoulakas, Efstratios, Mantzarlis, Konstantinos, Apostolopoulou, Olimpia, Sfyras, Dimitrios, Zakynthinos, Epaminondas
Format: Article
Language:English
Subjects:
Ampicillin
Analysis
Antibiotics
Colistin
Comparative analysis
Dosage and administration
Drug resistance
Drug therapy
Intensive care
Mortality
Nosocomial infections
Patient outcomes
Penicillin
Sulbactam
Treatment outcome
Ventilator-associated pneumonia
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Summary:Background: Retrospective studies have reported good clinical success rates using colistin as monotherapy to treat Acinetobacter baumannii ventilator-associated pneumonia (VAP), comparable to that obtained with colistin combined with other antibiotics. However, inadequate penetration into the pulmonary parenchyma for colistin has been shown in animal models. Aim: The aim of the study was to study prospectively the outcome, measured as clinical response and survival, of intravenously administered colistin versus colistin combined with high-dose ampicillin-sulbactam in Intensive Care Unit (ICU) patients with multiresistant A. baumannii VAP. Methods and Subjects: This prospective, open-label, randomized study included consecutive patients who developed microbiologically documented VAP due to A. baumannii with carbapenem-resistant strains but susceptible to colistin and ampicillin-sulbactam. Seventy-four patients were screened, but finally, 39 participants were enrolled and finished the study Patients received colistin (Group A - 19 patients) or colistin and ampicillin/sulbactam (Group B - 20 patients). The clinical response of VAP was assessed on day 4th to 5th of treatment (early response). If therapy was considered unsuccessful after this period, ampicillin/sulbactam was added in Group A or changed therapy in B. Results: Early cure rates in Group A and B were 15.8% and 70%, respectively (P = 0.001). Multiple regression analysis revealed that combination treatment (odds ratio [OR]: 43.6, 95% confidence interval [CI]: 3.594-530.9) and Sequential Organ Failure Assessment score
ISSN:0972-5229
1998-359X
DOI:10.4103/ijccm.IJCCM_302_17