Trimethoprim-sulfamethoxazole vs. colistin or ampicillin–sulbactam for the treatment of carbapenem-resistant Acinetobacter baumannii: A retrospective matched cohort study. (June 2019)

• Record Type: Journal Article
• Authors: Raz-Pasteur, Ayelet; Liron, Yael; Amir-Ronen, Reut; Abdelgani, Siham; Ohanyan, Astghik; Geffen, Yuval; Paul, Mical
• Is Part Of: Journal of global antimicrobial resistance. Volume 17(2019)
• Page Start: 168
• Page End: 172
• Publication Date: 2019-06
• Subjects: Acinetobacter baumannii -- Trimethoprim–sulfamethoxazole -- Colistin -- Multidrug resistant bacteria; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2018.12.001
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: Few options are available to treat carbapenem-resistant Acinobacter baumannii ( A. baumannii ). About 30% of A. baumannii isolates are susceptible to trimethoprim–sulfamethoxazole in Israel. Trimethoprim–sulfamethoxazole was used as monotherapy to treat A. baumannii . Trimethoprim–sulfamethoxazole was non-inferior to colistin and ampicillin–sulbactam. Abstract: Objectives: This study aimed to assess the effectiveness of trimethoprim–sulfamethoxazole (TMP/SMX) as monotherapy for the treatment of carbapenem-resistant Acinobacter baumannii ( A. baumannii ) (CRAB) infections. Methods: This retrospective cohort study included patients receiving TMP/SMX as the main treatment for severe infections caused by CRAB, who were matched with patients treated with colistin or ampicillin–sulbactam (AMP/SUL) by age, Charlson score, department, and source of infection. Outcomes were compared among all patients and in a subgroup of propensity-score (PS) matched patients. The PS matching was performed using a match tolerance of 0.15 with replacement. Results: Fifty-three patients treated with TMP/SMX and 83 matched patients treated with colistin or AMP/SUL were included. Variables that were independently significantly associated with TMP/SMX treatment included admission for infection and septic shock, while abnormal cognition on admission and intensive care unit admission were associated with colistin or AMP/SUL treatment. All-cause 30-day mortality was lower with TMP/SMX compared with the comparator antibiotics among all patients (24.5%, 13 of 53 vs. 38.6%, 32 of 83, P = 0.09) and in the PS-matched subgroup (29%, 9 of 31 vs. 55.2% 16 of 29, P = 0.04). Treatment failure rates were not significantly different overall (34%, 18 of 53 vs. 42.4%, 35 of 83, P = 0.339) and in the PS-matched subgroup (35.5%, 11 of 31 vs. 44.8%, 13 of 29, P = 0.46). Time to clinical stability and hospitalization duration were significantly shorter with TMP/SMX. Patients treated with TMP/SMX probably had less severe infections than those treated with other antibiotics, even after matching. Conclusions: TMP/SMX might be a valuable treatment option for TMP/SMX-susceptible CRAB infections. Given the very limited available treatment options, further studies assessing its effectiveness and safety are necessary.