Treatment outcomes of patients with non-bacteremic pneumonia caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex isolates: Is there any benefit of adding tigecycline to aerosolized colistimethate sodium?
Journal
Medicine (United States)
Journal Volume
97
Journal Issue
39
Pages
e12278
Date Issued
2018
Author(s)
Abstract
Few therapeutic options exist for various infections caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (XDR-Acb) complex isolates, including pneumonia. This study investigated the clinical efficacy between aerosolized colistimethate sodium (AS-CMS, 2 million units thrice a day) treatment alone or in combination with standard-dose tigecycline (TGC) in patients with non-bacteremic pneumonia due to XDR-Acb, and explored the factors influencing patients' 30-day mortality. A 1:1 case (n=106; receiving TGC plus AS-CMS) control (receiving AS-CMS alone with matching scores) observational study was conducted among adult patients with non-bacteremic XDR-Acb complex pneumonia in a Taiwanese medical center from January 2014 through December 2016. The clinically relevant data were retrospectively recorded. The primary endpoint was 30-day case fatality. Secondary endpoints investigated that if the co-morbidities, XDR-A. baumannii as a pneumonic pathogen, therapy-related factors, or airway colonization with colistin-resistant Acb negatively influenced the 14-day clinical condition of enrolled patients. A higher 30-day mortality rate was noted among the group receiving combination therapy (34.0% vs 22.6%; P=.17). The ?7-day AS-CMS therapy successfully eradicated > 90% of airway XDR-Acb isolates. Nevertheless, follow-up sputum specimens from 10 (6.4% [10/156]) patients were colonized with colistin-resistant Acb isolates. After the conditional factors were adjusted by multivariate logistic analysis, the only factor independently predicting the 30-day case-fatality was the failure of treating XDR-Acb pneumonia at 14 days (adjusted odds ratio [aOR]=38.2; 95% confidence interval [CI]=9.96-142.29; P<.001). Cox proportional regression analysis found that chronic obstructive pulmonary disease (COPD) (adjusted hazard ratio [aHR]=2.08; 95% CI=1.05-4.10; P=.035), chronic renal failure (aHR=3.00; 95% CI=1.52-5.90; P=.002), non-invasive ventilation use (aHR=2.68; 95% CI=1.37- 5.25; P=.004), and lack of TGC therapy (aHR=0.52; 95% CI=0.27-1.00; P=.049) adversely influenced the 14-day clinical outcomes. Conversely, the emergence of colistin-resistant Acb isolates in the follow-up sputum samples was not statistically significantly associated with curing or improving XDR-Acb pneumonia. In conclusion, aggressive pulmonary hygiene care, the addition of TGC, and corticosteroid dose tapering were beneficial in improving the 14-day patients' outcomes. ? 2018 the Author(s).
SDGs
Other Subjects
amikacin; carbapenem; ciprofloxacin; colistimethate; colistin; gentamicin; isepamicin; piperacillin plus tazobactam; tigecycline; antiinfective agent; colistin; colistinmethanesulfonic acid; minocycline; tigecycline; adult; aged; antibiotic resistance; antibiotic therapy; Article; case control study; case fatality rate; chronic kidney failure; chronic obstructive lung disease; comorbidity; controlled study; female; follow up; human; major clinical study; male; mortality; mortality rate; multidrug resistant Acinetobacter baumannii; noninvasive ventilation; observational study; pneumonia; priority journal; regression analysis; retrospective study; steroid therapy; Taiwanese; treatment failure; treatment outcome; Acinetobacter; Acinetobacter infection; analogs and derivatives; combination drug therapy; drug effect; isolation and purification; microbiology; middle aged; multidrug resistance; pneumonia; survival rate; Taiwan; very elderly; Acinetobacter; Acinetobacter Infections; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Case-Control Studies; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Pneumonia; Retrospective Studies; Survival Rate; Taiwan; Treatment Outcome
Type
journal article