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The Mortality of Colistin Monotherapy vs. Colistin-Sulbactam for Carbapenem-Resistant Acinetobacter baumannii
Nadia Cheh-Oh1,2, Chutchawan Ungthammakhun3, Dhitiwat Changpradub3
1College of Pharmacotherapy Thailand, Nonthaburi, Thailand.
Background:
This study compared the mortality rates within 30 days of 2 different doses of sulbactam (6 g and 9-12 g daily) when used in colistin (COL)-based treatment regimens and COL monotherapy for carbapenem-resistant Acinetobacter baumannii (CRAB).
Materials And Methods:
This retrospective cohort study included 234 participants diagnosed with severe pneumonia due to CRAB infection at Phramongkutklao Hospital, Thailand, from July 1, 2011, to April 30, 2023. Participants were categorized into three groups: COL monotherapy, COL with 6 g of sulbactam daily (COL+S6g), and COL with 9-12 g of sulbactam daily (COL+SHD). Following the exclusion of patients with renal impairment (serum creatinine ≥1.5 mg/dl), a 1:2 propensity score (PS) matching was used to ensure comparable groups, with the COL group designated as the control. The matching variables included age, APACHE II scores, serum creatinine, intensive care units admission, and bacteremia. The number of participants in each group was as follows: 19 in COL, 32 in COL+S6g, and 38 in COL+SHD. The primary outcomes assessed were all-cause mortality rates at 7, 14, and 30 days. Kaplan-Meier survival curves and the Log-rank test were used to evaluate differences between groups, while multivariate Cox regression models were applied to determine the impact of treatment regimens.
Results:
The unmatching PS analysis indicated that the COL+SHD regimen significantly reduces mortality compared to the COL regimen; hazard ratios (HR) were 0.18 (95% confidence interval [CI], 0.06-0.55) for 7-day mortality and 0.53 (95% CI,-0.29-0.97) for 30-day mortality. In addition, the COL+SHD regimen also lowered mortality more than the COL+S6g regimen within 7 days (HR, 0.29; 95% CI, 0.11-0.75). After PS matching, the COL+SHD regimen significantly reduced 7-day mortality compared to the COL regimen (adjusted HR, 0.24; 95% CI, -0.07-0.82). However, COL+S6g did not differ in mortality from either COL+SHD or COL for 7-day mortality. At 14 days and 30 days, there were no significant regimens to reduce mortality.
Conclusion:
Combining COL+SHD effectively reduced death in 7 days from severe pneumonia in CRAB infection treatment.
Insights
High-dose sulbactam combined with colistin significantly reduced 7-day mortality in patients with carbapenem-resistant Acinetobacter baumannii pneumonia. This combination therapy offers a promising treatment option for severe CRAB infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Severe pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB) presents a significant treatment challenge.
- Colistin (COL)-based regimens are often employed for CRAB infections, but their efficacy can be variable.
- Optimizing adjunctive therapies, such as sulbactam, is crucial for improving outcomes.
Purpose of the Study:
- To compare the 30-day mortality rates of different sulbactam dosages (6 g vs. 9-12 g daily) when combined with colistin (COL) versus COL monotherapy.
- To evaluate the impact of these treatment regimens on severe pneumonia due to CRAB infection.
Main Methods:
- A retrospective cohort study involving 234 patients with severe CRAB pneumonia.
- Patients were grouped into: COL monotherapy, COL with 6 g sulbactam (COL+S6g), and COL with 9-12 g sulbactam (COL+SHD).
- Propensity score matching was used to control for confounding factors, with mortality assessed at 7, 14, and 30 days.
Main Results:
- Unmatched analysis showed COL+SHD significantly reduced 7-day and 30-day mortality compared to COL monotherapy.
- COL+SHD also demonstrated lower 7-day mortality compared to COL+S6g.
- After propensity score matching, COL+SHD significantly reduced 7-day mortality, though no significant differences were observed at 14 or 30 days for any regimen.
Conclusions:
- The combination of colistin with high-dose sulbactam (COL+SHD) effectively reduced 7-day mortality in patients with severe CRAB pneumonia.
- This regimen represents a potentially superior treatment strategy for critical CRAB infections.
- Further research may explore optimal dosing and long-term outcomes.
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