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Colistin monotherapy versus colistin-based combination therapy in the treatment of extensive drug-resistant Acinetobacter baumannii infections: A retrospective cohort study
Awad Al-Omari1, Waleed Alhazzani2, Maha F Al-Subaie3, Ziad Memish4, Hesham Abdelwahed5, Jinhui Ma6, Mohammed Abdullah Alamri7, Saleem Saleh Alenazi8, Haifa Al-Shammari9, Hazem Aljomaah8, Samer Salih10, Suleiman Al-Obeid8
1 Department of Critical Care, Dr. Sulaiman Al Habib Medical Group, Riyadh, KSA
2 McMaster University, Division of Critical Care, Hamilton, Canada
3 Department of Pharmacy, Security Forces Hospital, Riyadh, KSA
4 Department of Medicine, Infectious Diseases Division, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, KSA
5 Department of Critical Care, Security Forces Hospital, Riyadh, KSA
6 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
7 Internal Medicine Department, Medical student at King Abdul-Aziz University, Jeddah, KSA
8 Department of Internal Medicine, Security Forces Hospital, Riyadh, KSA
9 Department of Pathology, King Saud Medical City, Jeddah, KSA
10 Department of Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Riyadh, KSA
Correspondence Address:
Awad Al-Omari
Department of Critical Care, Dr. Sulaiman Al Habib Medical Group, Riyadh
KSA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/sccj.sccj_18_17
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Introduction: Acinetobacter baumannii is a Gram-negative Coccobacillus and is a frequent cause of hospital-acquired infections. Because some strains of A. baumannii are resistant to many antibiotics (i.e., extensively drug-resistant A. baumannii, or XDRAB), selecting antibiotics to treat infected patients is challenging. Clinical outcomes in critically ill patients with XDRAB infections are poor. In this study, we evaluated the clinical effectiveness of colistin as monotherapy and in combination with other antibiotics. Patients and Methods: A retrospective cohort study was performed on 94 critically ill patients (age ≥18 years) to assess the clinical effectiveness of treating XDRAB infections with colistin, either in monotherapy or combination with tigecycline, meropenem, or both. Clinical and microbiological data were obtained from patient records. We included patients suffering from XDRAB ventilation-associated pneumonia (VAP), or ventilator-associated tracheobronchitis (VAT), or VAT with bacteremia. Results: The mean age of the patients was 53.3 years (±23.7 years), and the mean Acute Physiology and Chronic Health Evaluation II score was 22.7 (standard deviation = 7.1). VAP and VAT with bacteremia were found in 84% and 16% of patients, respectively. Half (51%) of patients achieved microbiological clearance. The median Intensive Care Unit (ICU) stay was 29 days (interquartile range [IQR]: 17, 55) and the median mechanical ventilation (MV) duration was 21 days (IQR: 12, 42). MV duration and ICU length of stay were lower in the group of patients treated with colistin and meropenem than in those treated with colistin alone. Mortality was significantly lower in patients who received (colistin and tigecycline 30%) than in those who were treated with monotherapy (75%) with an odd ratio 0.03 (95% confidence interval: 0.00, 0.32; P < 0.01). Conclusions: Colistin-based combination treatment regimens mainly with tigecycline or with tigecycline and meropenem were associated with better treatment outcomes of XDRAB-induced VAP and VAT with bacteremia than colistin monotherapy.
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