Comparison of Tigecycline or Cefoperazone/Sulbactam therapy for bloodstream infection due to Carbapenem-resistant Acinetobacter baumannii

• Published in: Antimicrobial resistance & infection control Vol. 8; no. 1; p. 52
• Main Authors: Niu, Tianshui, Luo, Qixia, Li, Yaqing, Zhou, Yanzi, Yu, Wei, Xiao, Yonghong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 06.03.2019; BioMed Central; BMC
• Subjects: Acinetobacter baumannii; Acinetobacter baumannii - drug effects; Acinetobacter baumannii - isolation & purification; Acinetobacter Infections - drug therapy; Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; Bacteremia - drug therapy; Bacteremia - microbiology; Bacterial infections; Carbapenem resistance; Carbapenems; Care and treatment; Cefoperazone - pharmacology; Cefoperazone - therapeutic use; Cefoperazone/sulbactam; Child; Child, Preschool; Disease control; Drug resistance; Drug Resistance, Bacterial - drug effects; Drug Synergism; Drug Therapy, Combination; FDA approval; Female; Health aspects; Hospitals; Humans; Imipenem; Infection; Intensive care; Male; Medical prognosis; Medical research; Medical schools; Meropenem; Microbial Sensitivity Tests; Middle Aged; Mortality; Nosocomial infections; Pathogens; Patients; Pneumonia; Prognosis; Regression analysis; Retrospective Studies; Sepsis; Studies; Sulbactam; Sulbactam - pharmacology; Sulbactam - therapeutic use; Survival Analysis; Tigecycline; Tigecycline - pharmacology; Tigecycline - therapeutic use; Treatment Outcome; Young Adult; United States > US; China; Cefoperazone/sulbactam; Acinetobacter baumannii; Carbapenem resistance; Tigecycline
• ISSN: 2047-2994; 2047-2994
• DOI: 10.1186/s13756-019-0502-x

We retrospectively analyzed the effect of tigecycline and cefoperazone/sulbactam therapies on the prognosis of patients with carbapenem-resistant bloodstream infection (CRAB-BSI). CRAB-BSI patients receiving tigecycline therapy or cefoperazone/sulbactam therapy between January 2012 and December 2017 was enrolled, and strict exclusion criteria were followed. The 28-day mortality of patients was analyzed. The impact of cefoperazone/sulbactam therapy on prognosis was evaluated using Cox multivariate regression analysis. The 28-day mortality of patients receiving cefoperazone/sulbactam monotherapy and cefoperazone/sulbactam-based combination therapy was also compared. Three hundred forty eight patients with CRAB-BSI were enrolled in the study. Two hundred ten patients were included after applying the exclusion criteria. Of these, 135 patients received tigecycline therapy and 75 patients received cefoperazone/sulbactam therapy. The 28-day mortality of patients in the latter group was, significantly lower than that of the tigecycline group [29.3% vs. 51.9%;  = 0.001]. Cox multivariate regression analysis revealed that cefoperazone/sulbactam therapy exerted a protective effect on the prognosis of patients [hazard ratio 0.566, 95% confidence interval (0.342-0.940);  = 0.028]. Kaplan-Meier survival curve analysis indicated that the 28-day mortality of patients receiving cefoperazone/sulbactam therapy was lower than that of patients receiving cefoperazone/sulbactam monotherapy, but the difference was not significant (22.2% vs. 40%;  = 0.074). However, the mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin was significantly lower than that of patients receiving cefoperazone/sulbactam monotherapy (  = 0.048). Patients treated with cefoperazone/sulbactam therapy had a better clinical outcome. The mortality of patients receiving cefoperazone/sulbactam with imipenem/cilastatin seems to be the lowest.