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What is the optimal antibiotic treatment strategy for carbapenem-resistant Acinetobacter baumannii (CRAB)? A
Hyeri Seok1, Won Suk Choi1, Shinwon Lee2
1Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
Insights
Optimal treatment for carbapenem-resistant Acinetobacter baumannii (CRAB) infections remains challenging. Combination therapies with colistin-carbapenem or sulbactam improved survival, while colistin monotherapy increased mortality.
Area of Science:
- Infectious Diseases
- Clinical Pharmacology
- Antimicrobial Resistance
Background:
- Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a significant global health threat due to limited effective treatment options.
- High endemicity of CRAB necessitates investigation into optimal therapeutic strategies.
Purpose of the Study:
- To evaluate the efficacy of various antibiotic types and regimens for treating CRAB infections.
- To assess the impact of different treatment strategies on mortality and clinical outcomes.
- To identify potential adverse drug reactions associated with CRAB treatments.
Main Methods:
- A multicentre retrospective study involving 282 patients across 10 tertiary hospitals in the Republic of Korea.
- Evaluation of 7-day and 28-day mortality, clinical, and microbiological responses.
- Assessment of nephrotoxicity and hepatotoxicity as adverse events.
Main Results:
- Colistin and minocycline demonstrated high susceptibility rates (99.6% and 80.4%, respectively).
- Combination therapy with colistin and carbapenem reduced 7-day mortality; sulbactam-containing regimens reduced 28-day mortality.
- Minocycline-containing regimens yielded the best microbiological responses, while colistin monotherapy was linked to increased mortality.
Conclusions:
- Combination therapy (colistin-carbapenem, sulbactam-containing) may improve CRAB infection mortality.
- Colistin monotherapy requires cautious use in severe CRAB infections or pneumonia.
- Minocycline-containing regimens show promise for microbiological clearance; further studies on mortality benefits are warranted.
Objectives:
The optimal treatment option for carbapenem-resistant Acinetobacter baumannii (CRAB) is still limited. This study investigated the efficacy of three or more antibiotic types and regimens for treatment of CRAB infection in high CRAB endemic areas.
Methods:
A multicentre retrospective study was conducted to evaluate the efficacy of treatment types and regimens of CRAB infections in 10 tertiary hospitals in the Republic of Korea. The outcomes comprised 7-day and 28-day mortality, and clinical and microbiological responses at 7 days, 28 days, and the end of treatment. Nephrotoxicity and hepatotoxicity were evaluated as drug adverse reactions.
Results:
A total of 282 patients were included in the study. Among the CRAB strains, the two most susceptible antibiotics were colistin (99.6%) and minocycline (80.4%). A combination of colistin and carbapenem significantly reduced 7-day mortality, and a sulbactam-containing regimen significantly reduced 28-day mortality. Colistin monotherapy was significantly associated with increased 7-day and 28-day mortality. A minocycline-containing regimen showed the best microbiological responses at 7 days, 28 days, and the end of treatment. Colistin and tigecycline were associated with increased nephrotoxicity and hepatotoxicity, respectively. Subgroup analysis of patients with pneumonia showed similar results to the overall CRAB infection.
Conclusions:
A combination of colistin and carbapenem and sulbactam-containing regimen may contribute improved mortality in CRAB infections. Colistin monotherapy should be considered cautiously in severe CRAB infections or CRAB pneumonia. A minocycline-containing regimen showed the best microbiological responses, and further studies may be needed to evaluate improved mortality.
