Clinical Efficacy and Nephrotoxicity of Colistin Alone versus Colistin Plus Vancomycin in Critically Ill Patients Infected with Carbapenem-Resistant Acinetobacter baumannii: A Propensity Score-Matched Analysis

Abstract

Acinetobacter baumannii has emerged as a significant concern worldwide. The mortality rate of carbapenem-resistant A. baumannii (CRAB) is increasing, especially in the intensive care unit (ICU). Thus, the objective of this study is to compare the efficacy and safety of colistin plus vancomycin for the treatment of critically ill patients with CRAB in Chiang Mai University Hospital. We conducted a retrospective cohort study of critically ill patients in the ICU with CRAB infection who received colistin alone or colistin-vancomycin combination therapy at Chiang Mai University Hospital. A total of 365 critically ill patients met the inclusion criteria. The results in this study showed that after propensity score matching, colistin plus vancomycin showed no significant differences in the 30-day mortality compared to colistin alone. Likewise, for colistin plus vancomycin, compared with colistin therapy alone, there were no significant differences in the clinical response, microbiological response and nephrotoxicity. In conclusion, colistin plus vancomycin was no significant differences in 30-day mortality, clinical response, microbiological response compared to colistin alone for infections due to CRAB. The nephrotoxicity rates were similar for both groups, so colistin combination with vancomycin was not necessary for the management of infection caused by CRAB.

Colistin-Induced Acute Kidney Injury and the Effect on Survival in Patients with Multidrug-Resistant Gram-Negative Infections: Significance of Drug Doses Adjusted to Ideal Body Weight

“…Concurrent uses of other potentially nephrotoxic drugs with colistin have been reported as augmentation risks of AKI; for example, vancomycin can induce kidney injury via proinflammatory oxidation, mitochondrial dysfunction, and cellular apoptosis [ 44 ]. Whether treatment with combined vancomycin and colistin increases the risk of AKI is still controversial [ 6 , 11 , 34 , 45 ] depending on related factors such as the studied population, severity of illness, drug dosage, and duration of the combination. The findings of multivariate analysis in this study supported the augmented risk of AKI by vancomycin.…”

Short-Course Versus Long-Course Colistin for Treatment of Carbapenem-Resistant A.baumannii in Cancer Patient

“…In some recent studies, the duration of antibiotic therapy for Acinetobacter baumannii infection was not well defined [ 10 , 11 , 12 , 13 , 14 ]. In previous studies, the definition typically used for short-course treatment was less than 10 days, while long-course treatment was typically defined as more than or equal to 10 days [ 15 , 16 , 17 ].…”

“…In the clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society (IDSA/ATS), a 7-day course of antimicrobial therapy was strongly recommended for hospital-acquired and ventilator-associated pneumonia rather than a longer duration, even in non-fermentative Gram-negative bacilli infection including P. aeruginosa and A. baumannii [ 19 ]. Remarkably, A. baumannii might be one of the most debated pathogens for antibiotic treatment duration; many clinicians usually consider continuation of antibiotic therapy for up to 2 weeks in many patients with established infection [ 10 , 11 , 12 , 13 , 14 ]. However, using antibiotics for 14 days was classified as a long treatment duration in many studies and guidelines [ 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…Remarkably, A. baumannii might be one of the most debated pathogens for antibiotic treatment duration; many clinicians usually consider continuation of antibiotic therapy for up to 2 weeks in many patients with established infection [ 10 , 11 , 12 , 13 , 14 ]. However, using antibiotics for 14 days was classified as a long treatment duration in many studies and guidelines [ 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 ]. Based on the mentioned information, especially in immunocompromised patients, a 14-day duration was defined as long course therapy; this cut-off was longer than most studies but was set based on the principle of immunocompromised status of patients [ 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…However, using antibiotics for 14 days was classified as a long treatment duration in many studies and guidelines [ 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 ]. Based on the mentioned information, especially in immunocompromised patients, a 14-day duration was defined as long course therapy; this cut-off was longer than most studies but was set based on the principle of immunocompromised status of patients [ 9 , 10 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 ]. Nevertheless, with regard to the patient distribution, where approximately 70% of patients in the long-course group received 14 days of treatment, the effect on the 14-day patients could dominate the effect of other patients.…”