Efficacy of colistin monotherapy versus colistin-based combination therapy for multidrug-resistance Acinetobacter baumannii pneumonia
Keywords:
Pneumonia, Acinetobacter baumannii, antimicrobial therapy, colistinAbstract
Objective : To compare the 28-day mortality, and nephrotoxicity rate between colistin monotherapy (CM), and colistin-based combination therapy (BC) in patients with A. baumanii MDR pneumonia.
Method : A retrospective cohort study was conducted on the data of patients 18 years old and older who were diagnosed with A. baumannii MDR from respiratory specimens and received treatment with colistin more than 72 hours. This data had been collected from October 1, 2015 to March 31, 2017. The comparison of the 28-day mortality and nephrotoxicity rate in CM and BC groups were then evaluated.
Result : Of 400 patients with A. baumanii MDR pneumonia, 129 (32.3%) and 271 (67.7%) patients had received CM and BC, respectively. BC group patients significantly had preexisting renal diseases less than CM group patients (3.9% VS 16.6%, p-value <0.05). However, there was no statistically significant difference about gender, age, and severity of the disease between two groups. For 28-day mortality, no differences were found between CM and BC groups (58.9% VS 59.4%, p-value 0.99). The nephrotoxicity rate was not significantly different between two groups (51.9% VS 58.3%, p-value 0.23).
Conclusion : Neither the administration of colistin only nor colistin with other antimicrobial agents had any noticeable treatment result of A. baumannii MDR pneumonia in terms of mortality and nephrotoxicity rate.
References
O Neill J. Review on antimicrobial resistance. Antimicrobial resistance: Tackling a crisis for the health and wealth of nations [Internet]. 2014 [2020, Mar, 6].Available from: www.amr-review.org/sites/default/files/AMRReviewPaperTacklingacrisisforthehealthandwealthofnations1.pdf.
สําลี ใจดี. รายงานสถานการณ์ระบบยา ประจําปี 2553. พิมพ์ครั้งที่ 1.กรุงเทพมหานคร. คณะเภสัชศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย; 2554;15-18.
Maleewong U, editors. Bangkok: แผนงานสร้างกลไกเฝ้าระวัง และพัฒนาระบบยา (กพย.) คณะเภสัชศาสตร์ จุฬาลงกรณ์มหาวิทยาลัย; 2010.
National Antimicrobial Resistance Surveillance Center Thailand (NARST). Antimicrobial resistance 2000-2017 [Internet]. 2017 [2020, Mar, 7]. Available from: www.narst.dmsc.moph.go.th
Wan Jie Gu, et al. Colistin for the treatment of ventilator-associated pneumonia caused by multidrug-resistant Gram-negative bacteria. International Journal of Antimicrobial Agents. 2014; 44: 477–485.
Fishbain J, Peleg AY. Treatment of Acinetobacter infections. Clin Infect Dis 2010; 51: 79-84.
Thamlikitkul V. Colistin: Antimicrobial for treatment resistant gram negative bacterial infection. Siriraj Medical Bulletin. 2008; 1: 152-8.
Michalopoulos A, Karatza D. Multidrug resistant gram-negative infections: the use of colistin [Internet]. 2014 [2020, Mar, 6]. Available from: www.doi. org/10.1586/eri.10.88 11. Ordooei Javan A, Shokouhi S, Sahraei Z.A review on colistin nephrotoxicity.Eur J Clin Pharmacol 2015; 71: 801-10.
Giamarellou H, Poulakou G. Multidrug-resistant gram-negative infections: what are the treatment options? Drugs 2009; 69: 1879-901.
Gilbert DN, Chambers HF, Eliopoulos GM, SaagMS, Pavia AT, Black D, et al. The Sanford guideline to antimicrobial therapy 2016. 46th ed. Sperryville: Antimicrobial Therapy; 2016. p112.
Acar Kaya I, et al. Evaluation of the synergistic effect of a combination of Colistin and tigecycline against multidrug-resistant Acinetobacter baumannii. Pak J Med Sci. 2017; 33(2): 393-397.
Pintip Pongpech, et al. Antibacterial Activity of Carbapenem-Based Combinations Againts Multidrug-Resistant Acinetobacter baumannii. J Med Assoc Thai. 2010; 93(2): 161-71.
Zusman O, Avni T, Leibovici L, et al. Systematic review and meta-analysis of in vitro synergy of polymyxins and Carbapenems. Antimicrob Agents Chemother. 2013; 57: 5104–11.
Gul Ruhsar Yilmaz, et al. Colistin alone or combined with sulbactam or Carbapenem against A. baumannii in ventilator-associated pneumonia. J Infect Dev Ctries. 2015; 9(5): 476-485.
Mical Paul, et al. Colistin alone versus Colistin plus Meropenem for treatment of severe infections caused by Carbapenem-resistant Gram-negative bacteria. Lancet Infect Dis. 2018.
Thamlikitkul V. A guide to the control and prevention of antimicrobial resistant bacteria in the hospital. Nonthaburi: Health Systems Research Institute; 2015.
Chatsuwan T, Paveenkittiporn W, Dubbs P. Activity of antimicrobial combinations against multidrug-resistant Acinetobacter baumannii and the association with resistance mechanisms: implication for treatment of infections caused by multidrug-resistant isolates [online]. 2017 [2020, Mar, 6]. Available from: www.cuir.car.chula.ac.th/hadle/123 456789/62952
Simsek F, et al. Colistin against colistin-only-susceptible Acinetobacter baumannii-related infections: Monotherapy or combination therapy? Indian journal of medical microbiology. 2012; 30: 448–452.
Bernard, R. (2000). Fundamentals of biostatistics (5th ed.). Duxbery: Thomson learning, 384-385.
Fleiss, J. L., Levin, B., Paik, M. C. (2003). Statistical methods for rates and proportions (3rd ed.). John Wiley&Sons, 76.
Ngamjarus C., Chongsuvivatwong V. (2014). n4Studies: Sample size and power calculations for android. The Royal Golden Jubilee Ph.D. Program - The Thailand Research Fund & Prince of Songkla University.
Kellum JA, Lameire N, Aspelin P, Macleod AM, Barsoum RS, Mehta RL, et al. Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury. Kidney Inter Suppl 2012; 2: 8-12.
Reechaipichitkul W. HAP, VAP and HCAP guidelines: from guidelines to clinical practice. Srinagarind Medical Journal. 2010; 25 (1): 87-94.
Kanankaeng W, Sriphong P. Regimens and clinical outcomes of antimicrobial uses in hospital-acquired pneumonia caused by drug resistant Acinetobacter baumannii. Thai Journal of Pharmacy Practice 2019; 11: 470–82.
Koomanachai P, Tiengrim S, Kiratisin P, Thamlikit- kul V. Effcacy and safety of colistin (colistimethate sodium) for therapy of infectious caused by multidrug resistant Pseudomonas aeruginosa and Acinetobacter baumannii in Siriraj Hospital, Bangkok, Thailand. Int J Infect Dis 2007; 11: 402-6.
Anusornsangiam W, Somsak N, Rahong W, Chaiya song S, Chaiyasong C. Incidence of adverse affect by colistin used in hospital. Journal of Science and Technology Mahasarakham University. 2017; 36: 589–96.
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