Abstract
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.
Highlights
Carbapenem-resistant Acinetobacter baumannii (CRAB) has been listed as a critical priority pathogen by the World Health Organization’s 2017 global priority list of antibioticresistant bacteria; these bacteria require the development of new antibiotics [1]
Patients who had polymicrobial pneumonia (n = 128), infections from other sources (n = 121), or meropenem–colistin or meropenem–tigecycline administered for less than three days (n = 8) were excluded from the analysis
90 patients treated with meropenem–colistin (n = 66) or meropenem–tigecycline (n = 24) as the initial effective antibiotics for at least three days were analyzed
Summary
Carbapenem-resistant Acinetobacter baumannii (CRAB) has been listed as a critical priority pathogen by the World Health Organization’s 2017 global priority list of antibioticresistant bacteria; these bacteria require the development of new antibiotics [1]. A. baumannii is a prevalent etiologic agent causing diverse nosocomial infections and whose resistance to carbapenem is remarkably high—95% in some parts of the world and 85% in the Republic of Korea [2,3]. It is the major pathogen isolated from hospitalacquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), with an imipenem resistance rate of 67.3% in Asian countries [4]. Colistin is often the last treatment option for CRAB pneumonia, based on antimicrobial susceptibility tests. It has been proven to be active in vitro against
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