Comparison of the clinical efficacy between tigecycline plus extended-infusion imipenem and sulbactam plus imipenem against ventilator-associated pneumonia with pneumonic extensively drug-resistant Acinetobacter baumannii bacteremia, and correlation of clinical efficacy with invitro synergy tests

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Abstract

Background/Purpose: To compare the clinical efficacy between salvage antimicrobial regimen consisting of tigecycline plus extended-infusion imipenem/cilastatin (TIC) and regimen of sulbactam plus imipenem/cilastatin (SIC) for patients with ventilator-associated pneumonia and pneumonic bacteremia due to extensively drug-resistant (XDR) Acinetobacter baumannii (Ab) isolates, and determine the correlation of results of invitro tigecycline-imipenem synergy test with clinical efficacy. Methods: The comparative survey was conducted at a medical center in Taiwan in 2013. Patients comprising the TIC group (n=28) received tigecycline plus extended-infusion imipenem/cilastatin following unresponsiveness to 3-day sulbactam-imipenem/cilastatin therapy, and those in the SIC group (n=56) received sulbactam-imipenem/cilastatin throughout the course. Univariate and multivariate analyses were applied to explore 30-day case-fatality independent predictors. Additionally, the checkerboard test and time-kill analysis were performed for the bloodstream XDR-Ab isolates from patients in the TIC group, and molecular characterization was done for the bloodstream XDR-Ab strains of all patients. Results: We found that the TIC scheme has a significant benefit on improving patients' survival status (the mortality rate of TIC and SIC group patients was 14.3% and 64.3%, respectively), corresponding well with invitro synergy or additivity results by the checkerboard test. Twenty TIC group cases had monomicrobial XDR-Ab cultured from tracheal aspirates after 10 days of tigecycline-imipenem/cilastatin therapy, but none developed subsequent pneumonia. However, breakthrough primary Burkholderia cepacia (n=3) and Pseudomonas aeruginosa (n=1) bacteremias were attributed to four TIC case fatalities. Shock, SIC regimen usage, and development of breakthrough bacteremia were independent predictors of 30-day in-hospital mortality. Conclusion: Although the TIC regimen showed good efficacy, its value regarding managing XDR-Ab ventilator-associated pneumonia bacteremia needs further evaluation.

Original languageEnglish
Pages (from-to)924-933
JournalJournal of Microbiology, Immunology and Infection
Volume49
Issue number6
DOIs
Publication statusPublished - Dec 1 2016

Fingerprint

Sulbactam
Ventilator-Associated Pneumonia
Acinetobacter baumannii
Imipenem
Bacteremia
Lung
Pharmaceutical Preparations
Burkholderia cepacia
tigecycline
imipenem drug combination cilastatin
Hospital Mortality
Taiwan
Pseudomonas aeruginosa
Shock
Pneumonia
Multivariate Analysis
Survival

Keywords

  • Combination regimen
  • Extensively drug-resistant Acinetobacter baumannii
  • Imipenem
  • Sulbactam
  • Tigecycline
  • Ventilator-associated pneumonia

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Infectious Diseases

Cite this

@article{520e7a6931e044febfa60f2ab3373526,
title = "Comparison of the clinical efficacy between tigecycline plus extended-infusion imipenem and sulbactam plus imipenem against ventilator-associated pneumonia with pneumonic extensively drug-resistant Acinetobacter baumannii bacteremia, and correlation of clinical efficacy with invitro synergy tests",
abstract = "Background/Purpose: To compare the clinical efficacy between salvage antimicrobial regimen consisting of tigecycline plus extended-infusion imipenem/cilastatin (TIC) and regimen of sulbactam plus imipenem/cilastatin (SIC) for patients with ventilator-associated pneumonia and pneumonic bacteremia due to extensively drug-resistant (XDR) Acinetobacter baumannii (Ab) isolates, and determine the correlation of results of invitro tigecycline-imipenem synergy test with clinical efficacy. Methods: The comparative survey was conducted at a medical center in Taiwan in 2013. Patients comprising the TIC group (n=28) received tigecycline plus extended-infusion imipenem/cilastatin following unresponsiveness to 3-day sulbactam-imipenem/cilastatin therapy, and those in the SIC group (n=56) received sulbactam-imipenem/cilastatin throughout the course. Univariate and multivariate analyses were applied to explore 30-day case-fatality independent predictors. Additionally, the checkerboard test and time-kill analysis were performed for the bloodstream XDR-Ab isolates from patients in the TIC group, and molecular characterization was done for the bloodstream XDR-Ab strains of all patients. Results: We found that the TIC scheme has a significant benefit on improving patients' survival status (the mortality rate of TIC and SIC group patients was 14.3{\%} and 64.3{\%}, respectively), corresponding well with invitro synergy or additivity results by the checkerboard test. Twenty TIC group cases had monomicrobial XDR-Ab cultured from tracheal aspirates after 10 days of tigecycline-imipenem/cilastatin therapy, but none developed subsequent pneumonia. However, breakthrough primary Burkholderia cepacia (n=3) and Pseudomonas aeruginosa (n=1) bacteremias were attributed to four TIC case fatalities. Shock, SIC regimen usage, and development of breakthrough bacteremia were independent predictors of 30-day in-hospital mortality. Conclusion: Although the TIC regimen showed good efficacy, its value regarding managing XDR-Ab ventilator-associated pneumonia bacteremia needs further evaluation.",
keywords = "Combination regimen, Extensively drug-resistant Acinetobacter baumannii, Imipenem, Sulbactam, Tigecycline, Ventilator-associated pneumonia",
author = "Jean, {Shio Shin} and Hsieh, {Tai Chin} and Hsu, {Chin Wan} and Lee, {Wen Sen} and Bai, {Kuan Jen} and Carlos Lam",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.jmii.2015.06.009",
language = "English",
volume = "49",
pages = "924--933",
journal = "Journal of Microbiology, Immunology and Infection",
issn = "0253-2662",
publisher = "Elsevier Taiwan LLC",
number = "6",

}

TY - JOUR

T1 - Comparison of the clinical efficacy between tigecycline plus extended-infusion imipenem and sulbactam plus imipenem against ventilator-associated pneumonia with pneumonic extensively drug-resistant Acinetobacter baumannii bacteremia, and correlation of clinical efficacy with invitro synergy tests

AU - Jean, Shio Shin

AU - Hsieh, Tai Chin

AU - Hsu, Chin Wan

AU - Lee, Wen Sen

AU - Bai, Kuan Jen

AU - Lam, Carlos

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background/Purpose: To compare the clinical efficacy between salvage antimicrobial regimen consisting of tigecycline plus extended-infusion imipenem/cilastatin (TIC) and regimen of sulbactam plus imipenem/cilastatin (SIC) for patients with ventilator-associated pneumonia and pneumonic bacteremia due to extensively drug-resistant (XDR) Acinetobacter baumannii (Ab) isolates, and determine the correlation of results of invitro tigecycline-imipenem synergy test with clinical efficacy. Methods: The comparative survey was conducted at a medical center in Taiwan in 2013. Patients comprising the TIC group (n=28) received tigecycline plus extended-infusion imipenem/cilastatin following unresponsiveness to 3-day sulbactam-imipenem/cilastatin therapy, and those in the SIC group (n=56) received sulbactam-imipenem/cilastatin throughout the course. Univariate and multivariate analyses were applied to explore 30-day case-fatality independent predictors. Additionally, the checkerboard test and time-kill analysis were performed for the bloodstream XDR-Ab isolates from patients in the TIC group, and molecular characterization was done for the bloodstream XDR-Ab strains of all patients. Results: We found that the TIC scheme has a significant benefit on improving patients' survival status (the mortality rate of TIC and SIC group patients was 14.3% and 64.3%, respectively), corresponding well with invitro synergy or additivity results by the checkerboard test. Twenty TIC group cases had monomicrobial XDR-Ab cultured from tracheal aspirates after 10 days of tigecycline-imipenem/cilastatin therapy, but none developed subsequent pneumonia. However, breakthrough primary Burkholderia cepacia (n=3) and Pseudomonas aeruginosa (n=1) bacteremias were attributed to four TIC case fatalities. Shock, SIC regimen usage, and development of breakthrough bacteremia were independent predictors of 30-day in-hospital mortality. Conclusion: Although the TIC regimen showed good efficacy, its value regarding managing XDR-Ab ventilator-associated pneumonia bacteremia needs further evaluation.

AB - Background/Purpose: To compare the clinical efficacy between salvage antimicrobial regimen consisting of tigecycline plus extended-infusion imipenem/cilastatin (TIC) and regimen of sulbactam plus imipenem/cilastatin (SIC) for patients with ventilator-associated pneumonia and pneumonic bacteremia due to extensively drug-resistant (XDR) Acinetobacter baumannii (Ab) isolates, and determine the correlation of results of invitro tigecycline-imipenem synergy test with clinical efficacy. Methods: The comparative survey was conducted at a medical center in Taiwan in 2013. Patients comprising the TIC group (n=28) received tigecycline plus extended-infusion imipenem/cilastatin following unresponsiveness to 3-day sulbactam-imipenem/cilastatin therapy, and those in the SIC group (n=56) received sulbactam-imipenem/cilastatin throughout the course. Univariate and multivariate analyses were applied to explore 30-day case-fatality independent predictors. Additionally, the checkerboard test and time-kill analysis were performed for the bloodstream XDR-Ab isolates from patients in the TIC group, and molecular characterization was done for the bloodstream XDR-Ab strains of all patients. Results: We found that the TIC scheme has a significant benefit on improving patients' survival status (the mortality rate of TIC and SIC group patients was 14.3% and 64.3%, respectively), corresponding well with invitro synergy or additivity results by the checkerboard test. Twenty TIC group cases had monomicrobial XDR-Ab cultured from tracheal aspirates after 10 days of tigecycline-imipenem/cilastatin therapy, but none developed subsequent pneumonia. However, breakthrough primary Burkholderia cepacia (n=3) and Pseudomonas aeruginosa (n=1) bacteremias were attributed to four TIC case fatalities. Shock, SIC regimen usage, and development of breakthrough bacteremia were independent predictors of 30-day in-hospital mortality. Conclusion: Although the TIC regimen showed good efficacy, its value regarding managing XDR-Ab ventilator-associated pneumonia bacteremia needs further evaluation.

KW - Combination regimen

KW - Extensively drug-resistant Acinetobacter baumannii

KW - Imipenem

KW - Sulbactam

KW - Tigecycline

KW - Ventilator-associated pneumonia

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U2 - 10.1016/j.jmii.2015.06.009

DO - 10.1016/j.jmii.2015.06.009

M3 - Article

VL - 49

SP - 924

EP - 933

JO - Journal of Microbiology, Immunology and Infection

JF - Journal of Microbiology, Immunology and Infection

SN - 0253-2662

IS - 6

ER -