title: [Cefoperazone-sulbactam plus minocycline in the treatment of extensively drug resistant Acinetobacter infections].
abstract: OBJECTIVE
  To explore the effects of cefoperazone-sulbactam (C/S) plus minocycline on extensively drug resistant Acinetobacter baumannii (XDRAB) infections in critically ill patients.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China. pumchshi@sina.com
authors.forename: Yan
authors.initials: Y
authors.lastname: Shi
authors.forename: Ying-chun
authors.initials: YC
authors.lastname: Xu
authors.forename: Ye
authors.initials: Y
authors.lastname: Liu
authors.forename: Wei
authors.initials: W
authors.lastname: Du
authors.forename: Xi
authors.initials: X
authors.lastname: Rui
authors.forename: Yao
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects; D000368:Aged; D000369:Aged, 80 and over; D002438:Cefoperazone / Q000008:administration & dosage / Q000627:therapeutic use*; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D013407:Sulbactam / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D002438:Cefoperazone; D008911:Minocycline; D013407:Sulbactam