Sulbactam treatment for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex.

Abstract

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.

• Authors: Huang-Shen Lin, Ming-Hsun Lee, Chun-Wen Cheng, Po-Chang Hsu, Hsieh-Shong Leu, Ching-Tai Huang, Jung-Jr Ye
• Journal: Infectious diseases (London, England) (Infect Dis (Lond)) Vol. 47 Issue 6 Pg. 370-8 (Jun 2015) ISSN: 2374-4243 [Electronic] England
• PMID: 25746600 (Publication Type: Comparative Study, Journal Article, Observational Study)

Chemical References

• Anti-Bacterial Agents
• Carbapenems
• sultamicillin
• Ampicillin
• Sulbactam

Topics

• Acinetobacter Infections
• Acinetobacter baumannii (drug effects, isolation & purification)
• Acinetobacter calcoaceticus (drug effects, isolation & purification)
• Adult
• Aged
• Ampicillin (administration & dosage, therapeutic use)
• Anti-Bacterial Agents (therapeutic use)
• Carbapenems (therapeutic use)
• Drug Resistance, Multiple, Bacterial
• Drug Therapy, Combination
• Female
• Humans
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Pneumonia, Bacterial (drug therapy, microbiology)
• Retrospective Studies
• Sulbactam (administration & dosage, therapeutic use)
• Taiwan
• Time Factors