Antibiotic Treatment of Acinetobacter baumannii Superinfection in Patients With SARS-CoV-2 Infection Admitted to Intensive Care Unit: An Observational Retrospective Study

Abstract

IntroductionIn COVID-19 patients on mechanical ventilation, VAP from Acinetobacter baumannii remains a crucial risk factor for death. Antibiotic resistance represents an important problem in treating this infection. This study aims to describe the evolution of the superinfection from PDR Acinetobacter baumannii in patients with acute respiratory failure from SARS-CoV-2 infection admitted to ICU and compare the impact of two different antibiotic strategies on microbiological negativization.MethodsSingle-center observational retrospective study, including patients admitted to our ICU from March 2020 to May 2021 for acute respiratory failure from SARS-CoV-2 infection who developed PDR Acinetobacter baumannii superinfection. Clinical data at ICU admission were collected, as well as the timing of isolation of Acinetobacter baumannii, its resistance profile, the site of infection, and the antibiotic therapy.ResultsOf the 32 patients enrolled, 10 patients (31.2%) were treated with the combination of high-dose ampicillin/sulbactam, high-dose tigecycline, intravenous and inhaled colistin (Protocol), the other 22 (68.8%) were treated with the combination of two antibiotics (Control). Of the 10 patients in the Protocol group, 8 patients (80%) received also fosfomycin. All patients (100%) in the Protocol group had microbiological negativization, while in the Control group microbiological negativization was observed in 8 (36.4%) patients, p < 0.01.ConclusionOur report shows microbiological negativization in all patients treated with the combination therapy of nebulized and intravenous colistin, high-dose tigecycline, and high-dose ampicillin/sulbactam. This combination of antibiotics seems to be a useful alternative when other treatments are not available or fail.

International Clones of High Risk of Acinetobacter Baumannii—Definitions, History, Properties and Perspectives

“…A. baumannii can cause infections of the skin and soft tissue, urinary tract infections, meningitis, bacteremia, and pneumonia, the latter being the most frequently reported [ 8 ]. Currently, clinical A. baumannii isolates usually show resistance to all first-line antibiotics, and polymyxins, tigecycline, and ampicillin/sulbactam have become the last resort of treatment for extensively drug-resistant (XDR) isolates in many cases [ 9 , 10 , 11 ]. In 2017, carbapenem-resistant A. baumannii was assigned a critical priority level by the World Health Organization (WHO) in terms of developing novel control, treatment, and prevention measures [ 12 ].…”

The significant role of Carbapenems-resistant Acinetobacter Baumannii in mortality rate of patients with COVID-19

“…Therefore, CR- A. baumannii is one of the most important bacterial pathogens that could lead to higher mortality rates in COVID-positive patients; hence, promptly detecting and treating patients is essential. To this end, Casarotta et al reported that the use of combination therapy of high-dose of tigecycline, intravenous colistin, and ampicillin/sulbactam could be effective for the treatment of MDR- A. baumannii in patients with COVID; however, more detailed studies are needed in this field [ 22 ].…”

Multidrug-Resistant Organism Infections of Inpatients in a Hospital in Eastern China from 2015 to 2021

“…there have been increasing reports of CRABA associated with hospital-acquired pneumonia, especially ventilatorassociated pneumonia. [22][23][24][25][26] The infection is difficult to treat may be related to the following reasons: First, once A. baumannii exhibits carbapenem resistance, resistance to most other antibiotics expected to be active against wildtype A. baumannii usually develops, leaving few therapeutic options. Second, there is no clear "gold standard" for evaluating the effectiveness of various treatment regimens for CRABA infection, and studies on the effectiveness of commonly used drug treatments are limited.…”