Sulbactam treatment for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex.
BACKGROUND
Multidrug-resistant (MDR) Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex has become an important cause of nosocomial pneumonia. Sulbactam is a β-lactamase inhibitor with antimicrobial activity against MDR Acb complex.


METHODS
To investigate outcomes of pneumonia involving MDR Acb complex treated with sulbactam or ampicillin/sulbactam for at least 7 days, we conducted a retrospective study of 173 adult patients over a 34 month period.


RESULTS
Of 173 patients, 138 (79.8%) received combination therapy, mainly with carbapenems (119/138, 86.2%). The clinical response rate was 67.6% and the 30 day mortality rate was 31.2%. The independent predictors of clinical failure were malignancy, bilateral pneumonia and shorter duration of treatment. In patients with sulbactam-susceptible strains, there was no difference in clinical and microbiological outcome between combination therapy and monotherapy. Compared to the sulbactam-susceptible group, the sulbactam-resistant group had a lower rate of airway eradication, a longer duration of treatment and a higher rate of combination therapy with predominantly carbapenems (p < 0.05). There was no significant difference between the two groups in clinical resolution and 30 day mortality rates.


CONCLUSIONS
Sulbactam could be a treatment option for pneumonia involving MDR Acb complex, and combination therapy with carbapenems could be considered for sulbactam-resistant cases.
From the Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Chia-Yi , Chia-Yi, Taiwan , ROC.
Huang-Shen
HS
Lin
Ming-Hsun
MH
Lee
Chun-Wen
CW
Cheng
Po-Chang
PC
Hsu
Hsieh-Shong
HS
Leu
Ching-Tai
CT
Huang
Jung-Jr
JJ
Ye
D000151:Acinetobacter Infections; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D016954:Acinetobacter calcoaceticus / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000382:microbiology; D012189:Retrospective Studies; D013407:Sulbactam / Q000008:administration & dosage / Q000627:therapeutic use*; D013624:Taiwan; D013997:Time Factors
D000900:Anti-Bacterial Agents; D015780:Carbapenems; C035444:sultamicillin; D000667:Ampicillin; D013407:Sulbactam
Acinetobacter calcoaceticus–Acinetobacter baumannii complex; multidrug-resistant; pneumonia; sulbactam