title: Colistin-based treatment for extensively drug-resistant Acinetobacter baumannii pneumonia.
abstract: Data for treatment and outcomes of extensively drug-resistant Acinetobacter baumannii (XDR-AB) pneumonia are limited. A retrospective cohort study of 236 adult patients with XDR-AB pneumonia was conducted between January 2009 and December 2012. The median age of subjects was 70 years (range 17-95 years), 53% were male, 55% had ventilator-associated pneumonia and 42% had been admitted to the intensive care unit. All XDR-AB isolates were susceptible only to tigecycline and colistin; 52 (22%) of the 236 subjects did not receive an agent active against XDR-AB, with an associated 28-day survival of 0%. Colistin-based two-drug combination treatment was prescribed to 166 subjects (70%); regimens included (i) colistin and high-dose sulbactam (n=93); (ii) colistin and tigecycline (n=43); and (iii) colistin and high-dose prolonged infusion of a carbapenem (n=30). The 28-day survival rate and mean length of hospital stay were not statistically different between these three regimens (65%, 53% and 60% and 39, 39 and 38 days, respectively). Predictors of mortality included Acute Physiology and Chronic Health Evaluation (APACHE) II score [adjusted odds ratio (aOR)=1.11; P<0.001 for each point increase], duration from infection onset to receipt of active regimen (aOR=1.01; P=0.002 for each hour delay), underlying malignancy (aOR=3.46; P=0.01) and chronic kidney disease (aOR=2.85; P=0.03). These findings suggest that the three colistin-based two-drug combination regimens may be treatment options for XDR-AB pneumonia.
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand. Electronic address: thanak30@yahoo.com.
authors.forename: Thana
authors.initials: T
authors.lastname: Khawcharoenporn
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
authors.forename: Nattapol
authors.initials: N
authors.lastname: Pruetpongpun
authors.affiliation: Thammasat University, Pathumthani, Thailand.
authors.forename: Pimsiri
authors.initials: P
authors.lastname: Tiamsak
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
authors.forename: Sasinuch
authors.initials: S
authors.lastname: Rutchanawech
authors.affiliation: GlaxoSmithKline, Collegeville, PA, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Mundy
authors.affiliation: Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
mesh_terms: D018806:APACHE; D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000401:mortality; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000472:pathogenicity; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use; D015331:Cohort Studies; D003091:Colistin / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000031:analogs & derivatives / Q000627:therapeutic use; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D012189:Retrospective Studies; D013407:Sulbactam / Q000627:therapeutic use; D000078304:Tigecycline; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000078304:Tigecycline; D008911:Minocycline; D013407:Sulbactam; D003091:Colistin
keywords: Acinetobacter baumannii; Colistin; Extensively drug-resistant; Outcomes; Pneumonia; Treatment