Cefoperazone-sulbactam plus minocycline in the treatment of extensively drug resistant Acinetobacter infections

Abstract

To explore the effects of cefoperazone-sulbactam (C/S) plus minocycline on extensively drug resistant Acinetobacter baumannii (XDRAB) infections in critically ill patients. For this prospective and single-center trial, a total of 101 patients with infection due to XDRAB received the primary therapy of C/S plus minocycline. Combined use of imipenem-cilastatin was considered when primary therapy failed. Among them, 77 patients were evaluated. There were 49 males and 28 females with a mean age of (69±20) years. The Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15±5. Among whom 61 had hospital-acquired pneumonia (n=61), primary bacteremia (n=5), intra-abdominal infection (n=3), skin and soft tissue infection (SSTI) (n=2) and multiple sites infection (n=6). Twenty-three patients had mixed bacterial infections. Combined use of imipenem-cilastatin therapy was administered in 7 patients. The treatment duration was (16±4) days. The outcomes were cure (n=21), marked improvement (n=27), improvement (n=26) and ineffectiveness (n=3). The overall effective rate was 62.3% (48/77) and the microbiological clearance rate 46.8% (36/77). The independent factors of decreased efficacy were underlying co-morbidity of impaired ability for infection control (OR=5.3, P=0.020), prolonged infection (OR=3.8, P=0.029), co-infecting organism (OR=3.5, P=0.032) and septic shock (OR=2.5, P=0.037). The combined regimen of C/S and minocycline is efficacious in the treatment of infections caused by XDRAB. But it has a lower rate of microbiological eradication.