Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: a randomized controlled trial.

Autor:	Ungthammakhun C; Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand., Vasikasin V; Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom. Electronic address: p.vasikasin20@imperial.ac.uk., Simsiriporn W; Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, Thailand., Juntanawiwat P; Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, Thailand., Changpradub D; Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand.
Jazyk:	angličtina
Zdroj:	International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases [Int J Infect Dis] 2024 Oct 16, pp. 107267. Date of Electronic Publication: 2024 Oct 16.
DOI:	10.1016/j.ijid.2024.107267
Abstrakt:	Background: The current treatment recommendation involves administering a high dose of sulbactam alongside at least one additional agent. However, there remains a lack of data regarding the optimal dosage of sulbactam. We investigated whether administering sulbactam at a dosage of 12 g/day decreases the mortality rate among patients with CRAB pneumonia compared to 9 g/day. Methods: The study was an open-label, superiority, randomized controlled trial conducted at Phramongkutklao Hospital between September 2019 and September 2023 in patients diagnosed with CRAB. Participants were randomly assigned to receive a combination of colistin with either 9 or 12 g/day of sulbactam. The primary endpoint was the all-cause mortality rate at 28 days post-randomization. Results: Among the 138 participants, there was a trend toward a lower mortality rate in the 12 g/day group (59.4% vs. 47.8%; p = 0.158). After adjusting for factors associated with mortality, a lower mortality was observed in the 12 g/day group (adjusted HR 0.54 [95% CI 0.33-0.87]; p = 0.0110). The microbiological cure rate at day 7 was higher in the 12 g/day group (73.2% vs. 89.4%; p = 0.02). Conclusions: Colistin in combination with sulbactam at a dosage of 12 g/day may improve mortality compared to 9 g/day. Competing Interests: CONFLICT OF INTEREST The authors declare that they have no conflicts of interest (Copyright © 2024. Published by Elsevier Ltd.)
Databáze:	MEDLINE
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