期刊
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
卷 69, 期 11, 页码 3119-3126出版社
OXFORD UNIV PRESS
DOI: 10.1093/jac/dku233
关键词
A; baumannii; combination treatment; antimicrobial resistance; healthcare-associated infections; nosocomial pneumonia
资金
- Ministerio de Economia y Competitividad, Instituto de Salud Carlos III - European Development Regional Fund 'A way to achieve Europe' ERDF
- Spanish Network for Research in Infectious Diseases [REIPI RD12/0015]
- Fondo de Investigaciones Sanitarias [PI10/00056, PI11/02046]
- Fondos Europeos de Desarrollo Regional-FEDER [PI10/00056, PI11/02046]
- Miguel Servet Programme (C.H.U.A Coruna)
- Miguel Servet Programme (ISCIII)
Treatment of multidrug-resistant Acinetobacter baumannii (MDRAB) infection presents a challenge because of the scarcity of available options. Even though combination therapy (CT) is frequently used in clinical practice, data are needed to support its use instead of monotherapy (MT). A prospective observational study was conducted in 28 Spanish hospitals. Patients with sepsis caused by MDRAB, defined according to strict criteria, and who received active antibiotic treatment (according to in vitro susceptibility testing) for at least 48 h, were included. The main outcome variable was all-cause 30 day mortality after initiation of targeted therapy. Multivariate analysis, including a propensity score (for receiving CT), was performed by Cox regression. One hundred and one patients were included in the analysis; 68 (67.3%) received MT and 33 (32.7%) received CT. Pneumonia was the most common infection (50.5%), 68.6% of cases being associated with mechanical ventilation. Colistin (67.6%) and carbapenems (14.7%) were the most common drugs used in MT; colistin plus tigecycline (27.3%) and carbapenem plus tigecycline (12.1%) were the most frequent combinations. Crude 30 day mortality was 23.5% and 24.2% for the MT and CT groups, respectively (RRaEuroS=aEuroS1.03; 95% CI 0.49-2.16; PaEuroS=aEuroS0.94). Multivariate analysis of 30 day survival showed no trend towards reduced 30 day mortality with CT (HRaEuroS=aEuroS1.35; 95% CI 0.53-3.44; PaEuroS=aEuroS0.53). Subgroup analysis showed similar results. Our data do not support an association of CT with reduced mortality in MDRAB infections. More data for specific types of infection and combinations are needed.
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