Abstract
Acinetobacter baumannii has emerged as a significant concern worldwide. The mortality rate of carbapenem-resistant A. baumannii (CRAB) is increasing, especially in the intensive care unit (ICU). Thus, the objective of this study is to compare the efficacy and safety of colistin plus vancomycin for the treatment of critically ill patients with CRAB in Chiang Mai University Hospital. We conducted a retrospective cohort study of critically ill patients in the ICU with CRAB infection who received colistin alone or colistin-vancomycin combination therapy at Chiang Mai University Hospital. A total of 365 critically ill patients met the inclusion criteria. The results in this study showed that after propensity score matching, colistin plus vancomycin showed no significant differences in the 30-day mortality compared to colistin alone. Likewise, for colistin plus vancomycin, compared with colistin therapy alone, there were no significant differences in the clinical response, microbiological response and nephrotoxicity. In conclusion, colistin plus vancomycin was no significant differences in 30-day mortality, clinical response, microbiological response compared to colistin alone for infections due to CRAB. The nephrotoxicity rates were similar for both groups, so colistin combination with vancomycin was not necessary for the management of infection caused by CRAB.
Highlights
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant concern worldwide
In critically ill patients with CRAB infections, 30-day mortality, clinical response and microbiological response do not differ in patients treated with colistin plus vancomycin compared to those receiving colistin alone
Our study showed no statistically significant difference in nephrotoxicity between groups of patients treated with colistin alone and those treated with colistin in combination with vancomycin (p = 0.474)
Summary
Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant concern worldwide. In Thailand, CRAB is one of the most common nosocomial pathogens, especially in the intensive care unit (ICU) [1]. CRAB infections have demonstrated increased lengths of hospital stays, mechanical ventilation and mortality ranging from 17 to 66% [2] because of critically ill patients whose prognosis is typically influenced by CRAB infection [3]. Appropriate treatment regimens for effective treatment of CRAB infections are very important and should be of concern [4]. Colistin is a salvage therapy for nosocomial infections caused by CRAB in the ICU [5]. An important limitation of colistin is a proclivity to the emergence of heterogeneous colistin resistance during treatment, especially if used as monotherapy [6,7]
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