Extensive drug resistant Acinetobacter baumannii: a comparative study between non-colistin based combinations
- 19 November 2019
- journal article
- research article
- Published by Springer Science and Business Media LLC in International Journal of Clinical Pharmacy
- Vol. 42 (1), 80-88
- https://doi.org/10.1007/s11096-019-00940-1
Abstract
Background The Gastrointestinal Surgery Center (GISC)—Mansoura University, faced a series of extensive drug resistant (XDR) A. baumannii cases, that were microbiologically resistant to penicillins, cephalosporins, fluoroquinolones, aminoglycosides, carbapenems and tigecycline. Colistin would have been a last resort therapy in such situation, however, intravenous polymyxins E (colistin) is relatively unavailable in Egypt. Many practitioners tried to form antibiotic combinations from the available antibiotics to overcome the resistance mechanisms of the pathogen. Objective Evaluate the clinical outcomes of these combinations retrospectively. Setting The study took place at the GISC, which is an academic specialized center affiliated with Mansoura University—Egypt. Method Clinical data were collected from the patients’ files, where the subjects were classified into two major groups according to the therapeutic intervention. Group 1 included 24 patients divided into 4 subgroups. The first was treated by a Cephalosporin with a Fluoroquinolone (1A), The second was treated by a Carbapenem with a Fluoroquinolone (1B), The third was treated by a B-lactam with an Aminoglycoside (1C) and the fourth was treated by Carbapenem with a Glycylcycline (1D). Group 2 included 6 patients, treated with Tigecycline and Ampicillin-Sulbactam. Main outcome measure Primary outcomes are the A. baumannii microbiological culture negativity after 14 days of therapy and the 30 days’ survival after the antibiotic course, while the secondary outcomes are the expected therapies’ side effects. Results Group 2 is associated with significant higher primary outcomes without a significant difference regarding the secondary outcomes. Conclusion The combination of Tigecycline and Ampicillin-Sulbactam, appears to be a clinically effective therapy against XDR A. baumannii, despite each agent being resistant alone, without alerting adverse effects.Keywords
Funding Information
- Mansoura University
This publication has 19 references indexed in Scilit:
- Triple combination therapy with high-dose ampicillin/sulbactam, high-dose tigecycline and colistin in the treatment of ventilator-associated pneumonia caused by pan-drug resistant Acinetobacter baumannii: a case series study.2019
- Comparison of the treatment efficacy between tigecycline plus high-dose cefoperazone-sulbactam and tigecycline monotherapy against ventilator-associated pneumonia caused by extensively drug-resistant Acinetobacter baumanniiInternational journal of clinical pharmacology and therapeutics, 2018
- Successful treatment of multidrug-resistant Acinetobacter baumannii meningitis with ampicillin sulbactam in primary hospitalBritish Journal Of Neurosurgery, 2017
- Sensitivity of levofloxacin in combination with ampicillin-sulbactam and tigecycline against multidrug-resistant Acinetobacter baumannii2017
- Tigecycline-based versus sulbactam-based treatment for pneumonia involving multidrug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complexBMC Infectious Diseases, 2016
- In vitro activities of rifampin, colistin, sulbactam and tigecycline tested alone and in combination against extensively drug-resistant Acinetobacter baumanniiThe Journal of Antibiotics, 2014
- In vitroactivity of tigecycline in combination with cefoperazone–sulbactam against multidrug-resistantAcinetobacter baumanniiJournal of Chemotherapy, 2014
- Antimicrobial susceptibility of tigecycline and comparators against bacterial isolates collected as part of the TEST study in Europe (2004–2007)International Journal of Antimicrobial Agents, 2009
- Colistin monotherapy vs. combination therapy: evidence from microbiological, animal and clinical studiesClinical Microbiology & Infection, 2008
- Colistin: The Revival of Polymyxins for the Management of Multidrug-Resistant Gram-Negative Bacterial InfectionsClinical Infectious Diseases, 2005