Outcomes of Adjunctive Therapy with Intravenous Cefoperazone-Sulbactam for Ventilator-Associated Pneumonia Due to Carbapenem-Resistant Acinetobacter baumannii

Abstract

The efficacy of adjunctive therapy with cefoperazone-sulbactam (CEP-SUL) for ventilator-associated pneumonia (VAP) due to carbapenem-resistant A. baumannii (CRAB) is unclear. Methods: We retrospectively analyzed the therapeutic effect of adding CEP-SUL to standard regimens for VAP due to CRAB. Patients with VAP due to CRAB strains that were susceptible to CEP-SUL were enrolled into the study. The patients were divided into two groups: those who receive cefoperazone-sulbactam (CEP-SUL + ), and those who did not receive cefoperazone-sulbactam (CEP-SUL). Mortality rates and resource utilization of these two groups were compared. Factors associated with mortality were explored. Results: Eighty patients were enrolled into the study, 52 CEP-SUL + and 28 CEP-SUL -. The baseline characteristics of the two groups were comparable, except for median Acute Physiology and Chronic Health Evaluation (APACHE) II score which was significantly higher for CEP-SUL + . Thirty-day, and in-hospital mortality rates for CEP-SUL + were significantly lower than CEP-SULwith values of 35%, 39% and 61%, 68%, for CEP-SUL + and CEP-SUL -, respectively. The survival rate for CEP-SUL + was significantly higher compared with CEP-SUL -(P < 0.001). The number of hospital days, ventilator days since diagnosis of VAP and hospital costs were lower for CEP-SUL + . Conclusion:Overall results suggested that patients with VAP due to CRAB strains who received adjunctive therapy with CEP-SUL had lower mortality rates and resource utilization compared with CEP-SUL -.

FAKTOR RISIKO AKUISISI BAKTERI CARBAPENEM-RESISTANT Acinetobacter baumannii PADA PASIEN DENGAN VENTILATOR ASSOCIATED PNEUMONIA

“…8 Antibiotik golongan carbapenem seperti imipenem dan meropenem merupakan antibiotik spektrum luas yang berpotensi efektif sebagai terapi infeksi Acinetobacter baumannii, namun penggunaan yang berlebihan menimbulkan risiko munculnya bakteri carbapenem resistant Acinetobacter baumannii (CRAB) yang merupakan bagian dari bakteri yang resisten terhadap berbagai antibiotik (multidrug resistant organism, MDRO). 9 Mekanisme utama resistensi bakteri terhadap antibiotik golongan carbapenem adalah hi-drolisis carbapenem oleh enzim carbapenemase yang dikode oleh plasmid. 10 Terapi VAP yang disebabkan oleh bakteri CRAB sangat sulit karena resisten terhadap berbagai antibiotik sehingga berakibat pada tingginya angka mortalitas VAP.…”

“…10 Terapi VAP yang disebabkan oleh bakteri CRAB sangat sulit karena resisten terhadap berbagai antibiotik sehingga berakibat pada tingginya angka mortalitas VAP. 9 Akuisisi bakteri MDRO dapat terjadi dalam bentuk kolonisasi atau infeksi. Kolonisasi MDRO merupakan salah satu faktor risiko infeksi yang disebabkan oleh MDRO.…”

Novel Siderophore Cephalosporin and Combinations of Cephalosporins with β-Lactamase Inhibitors as an Advancement in Treatment of Ventilator-Associated Pneumonia

“…A similar frequency of adverse events has been demonstrated, and AKI (acute kidney injury) and bone marrow aplasia were the most common AEs (adverse events). According to the study, adjuvant CFP-SBT therapy has a significant impact on survival among patients with VABP with a CRAB etiology [47].…”