Background: Acinetobacter baumannii, a common carbapenem-resistant gram-negative bacillus, usually causes nosocomial infections. Colistin has been used for carbapenem-resistant A. baumannii (CRAB) infections; however, only a few studies have evaluated colistin as a treatment option compared to appropriate controls. We investigated the effectiveness of colistin monotherapy in treating CRAB pneumonia compared to those treated without an active drug.
Methods: Adult patients (≥ 18 years) with CRAB isolated from respiratory specimens were screened from September 2017 to August 2022. Only patients with pneumonia treated with colistin monotherapy (colistin group) were included and compared to those without any active antibiotics (no active antibiotics [NAA] group). The primary and secondary outcomes were 30-day all-cause mortality and acute kidney injury within 30 days. The inverse probability of the treatment-weighted Cox proportional hazard model was used to compare mortality between groups.
Results: Among the 826 adult patients with CRAB in their respiratory specimens, 45 and 123 patients were included in the colistin and NAA groups, respectively. Most of the CRAB pneumonia (91.1%) cases were hospital-acquired pneumonia. The 30-day all-cause mortality rates in the colistin and NAA groups were 58.3% and 56.1%, respectively, and no difference was observed after adjustments (adjusted hazard ratio, 0.74; 95% CI, 0.47-1.17). The incidence of acute kidney injury was higher in the colistin group (65.3%) compared to the NAA group (39.0%) (P = 0.143).
Conclusions: Colistin monotherapy did not significantly improve treatment outcomes for CRAB pneumonia. The development and evaluation of new antimicrobials for CRAB pneumonia should be advocated in clinical practice.
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http://dx.doi.org/10.1016/j.jiph.2024.03.007 | DOI Listing |
Microbiol Spectr
December 2024
Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, South Korea.
Unlabelled: There is a critical need for treatment strategies to combat carbapenem-resistant Gram-negative pathogens. This study investigates the efficacy of combining low concentrations of colistin with tigecycline against colistin- and carbapenem-resistant and strains. We used two strains of KPC-2-producing and OXA-23-producing , both of which are highly colistin-resistant.
View Article and Find Full Text PDFInfect Drug Resist
November 2024
Department and Clinic of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland.
Background: MDR/XDR constitutes a difficult to treat bacteria in a number of infections as there are few therapeutic options. Promising drugs in such cases can be cefiderocol, aztreonam and ceftazidime/avibactam or meropenem/vaborbactam.
Case Presentation: A 72-year-old female patient with sepsis caused by KP NDM, OXA 48 was admitted to the Intensive Care Unit, immediately after an emergency graftectomy (of a recently transplanted kidney) complicated with bleeding.
Antibiotics (Basel)
October 2024
Haematology, Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy.
In children with acute leukemia (AL), the mortality rate from carbapenemase (KPC)-producing bloodstream infection (KPC-KpBSI) exceeds 50%, highest when active treatment is delayed. Neutropenic KPC- carriers are at high risk of KPC-KpBSI, and preemptive empiric antibiotic treatment (EAT) of febrile neutropenic episodes (FNEs) active against KPC- may reduce this mortality. We conducted an 8-year (2014-2021) retrospective observational study of 112 febrile neutropenic episodes (FNEs) in 32 children with AL who were KPC- carriers: standard EAT for 39 FNEs and active EAT for 73 FNEs (52 ceftazidime/avibactam (CAZAVI)-based and 21 colistin-based combinations, and 5 CAZAVI monotherapy).
View Article and Find Full Text PDFAntibiotics (Basel)
October 2024
Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, 80131 Naples, Italy.
Carbapenem-resistant (CRAB) poses significant challenges in healthcare due to its multidrug resistance and high mortality rates among critically ill patients. We enrolled 45 patients. Cefiderocol was administered to 40% of patients, often (38.
View Article and Find Full Text PDFAnn Med
December 2024
School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia.
: Complicated urinary tract infections are a significant cause of morbidity, hospitalization, and elevated hospital costs associated with kidney transplantations. The treatment of complicated urinary tract infections is very challenging, due to varying severities of infection and lower cure rates. The available drug options for treating these infections are limited, each with different mechanisms of action, efficacy, and safety profiles, making drug selection more difficult for healthcare professionals.
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