Abstract
BackgroundThe treatment options for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (MDR Acb) complex are limited, and the optimal treatment has not been established.MethodsTo compare the efficacy of tigecycline-based with sulbactam (or ampicillin/sulbactam)-based therapy for pneumonia involving MDR Acb complex, we conducted a retrospective study comparing 84 tigecycline-treated adult patients during the period August 2007 to March 2010 with 84 sulbactam or ampicillin/sulbactam-treated adult patients during the period September 2004 to July 2007. Both groups had the matched Acute Physiology and Chronic Health Evaluation (APACHE) II score and received treatment for at least 7 days.ResultsThe mean APACHE II score was 20.1 for both groups. More patients in sulbactam group had ventilator use (89.3 % versus 69.0 %), bilateral pneumonia (79.8 % versus 60.7 %) and combination therapy (84.5 % versus 53.6 %), particularly with carbapenems (71.4 % versus 6.0 %), while more patients in tigecycline group had delayed treatment (41.7 % versus 26.2 %) (P <0.05). At the end of treatment, more patients in sulbactam group had airway MDR Acb complex eradication (63.5 % versus 33.3 %, P <0.05). The clinical resolution rate was 66.7 % for both groups. The mortality rate during treatment was 17.9 % in sulbactam group, and 25.0 % in tigecycline group (P = 0.259). The multivariate analysis showed that bilateral pneumonia was the only independent predictor for mortality during treatment (adjusted odds ratio, 2.717; 95 % confidence interval, 1.015 to 7.272).ConclusionsPatients treated with either tigecycline-based or sulbactam-based therapy had a similar clinical outcome, but tigecycline group had a lower microbiological eradiation rate.
Highlights
The treatment options for pneumonia involving multidrug-resistant Acinetobacter calcoaceticusAcinetobacter baumannii (MDR Acb) complex are limited, and the optimal treatment has not been established
For pneumonia caused by MDR Acb complex resistant to carbapenems and other classes of antibiotics, off label use of tigecycline was common in clinical practice, and the clinical response rates ranged from 60 to 88 % in prior studies [9,10,11]
Demography and concomitant diseases One hundred and sixteen tigecycline-treated episodes of pneumonia involving MDR Acb complex were identified in 112 patients, while 177 sulbactam or ampicllin/ sulbactam-treated episodes were identified in 173 patients
Summary
The treatment options for pneumonia involving multidrug-resistant Acinetobacter calcoaceticusAcinetobacter baumannii (MDR Acb) complex are limited, and the optimal treatment has not been established. For pneumonia caused by MDR Acb complex resistant to carbapenems and other classes of antibiotics, off label use of tigecycline was common in clinical practice, and the clinical response rates ranged from 60 to 88 % in prior studies [9,10,11]. Sulbactam is a β-lactamase inhibitor with antimicrobial activity against Acinetobacter species [12] It is available alone or in combination with ampicillin, and ampicillin doesn’t contribute activity or synergism against A. baumannii [12]. Sulbactam or ampicillin/sulbactam had clinical response rates ranging from 67 to 75 % for pneumonia involving MDR A. baumannii (MDRAB) or MDR Acb complex in prior studies [13,14,15]
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