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Antimicrobial treatment and clinical outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia.
Antimicrobial treatment and clinical outcomes of carbapenem-resistant Acinetobacter baumannii ventilator-associated pneumonia.
- Source :
-
Journal of intensive care medicine [J Intensive Care Med] 2010 Nov-Dec; Vol. 25 (6), pp. 343-8. - Publication Year :
- 2010
-
Abstract
- Objectives: Carbapenem-resistant (CR) Acinetobacter baumannii is an important pathogen in ventilator-associated pneumonia (VAP), but therapeutic options are limited. We describe the clinical outcomes of the largest case series of CR-Acinetobacter VAP reported to date.<br />Methods: A retrospective analysis of 55 participants with CR-Acinetobacter VAP from July 2004 to December 2007 was undertaken. The primary endpoint was clinical response or microbiological eradication. Secondary endpoint was treatment-associated nephrotoxicity defined as ≥ 50% increase in serum creatinine or an increase of ≥ 0.5 mg/dL during therapy.<br />Results: Forty-two (76.4%) participants achieved clinical response at the completion of therapy. Clinical responses were achieved in 60.0% of sulbactam-based, 66.7% of polymyxin-based, 77.8% of aminoglycoside-based, 80.6% of minocycline-based, and 90.0% of tigecycline-based regimens. Follow-up sputum cultures were available in 6 of 10 tigecycline-treated participants with 4 of 6 isolates developing intermediate resistance to tigecycline while on therapy. Ten (18.2%) participants without preexisting renal disease developed treatment-associated nephrotoxicity. Baseline serum creatinine was 0.9 ± 0.1 mg/dL (range: 0.6-1.0 mg/dL) at the start of therapy and peaked at 1.9 ± 0.5 mg/dL (range: 1.6-3.0 mg/dL) during therapy. After excluding other potential concomitant renal toxic agents, nephrotoxicity developed in 6 of 30 (20.0%) and 4 of 7 (57.1%) participants treated with an aminoglycoside-or polymyxin-based regimen, respectively.<br />Conclusions: Our results demonstrated that CR-Acinetobacter VAP can be effectively treated with second-line agents. However, colistin-related nephrotoxicity was much higher than recently reported and decreased susceptibility to tigecycline emerged on therapy demonstrating the limitations of alternative regimens.
- Subjects :
- Adolescent
Adult
Aged
Aged, 80 and over
Carbapenems pharmacology
Carbapenems therapeutic use
Female
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Young Adult
Acinetobacter Infections drug therapy
Acinetobacter baumannii drug effects
Anti-Bacterial Agents therapeutic use
Pneumonia, Ventilator-Associated drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1525-1489
- Volume :
- 25
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of intensive care medicine
- Publication Type :
- Academic Journal
- Accession number :
- 20837632
- Full Text :
- https://doi.org/10.1177/0885066610377975