Oral doxycycline to carbapenem-resistant Acinetobacter baumanniiinfection as a polymyxin-sparing strategy: results from a retrospective cohort

Autor: Tuon, Felipe Francisco, Yamada, Carolina Hikari, de Andrade, Ana Paula, Arend, Lavinia Nery Villa Stangler, dos Santos Oliveira, Dayana, Telles, João Paulo
Zdroj: Brazilian Journal of Microbiology; 20230101, Issue: Preprints p1-8, 8p
Abstrakt: Acinetobacter baumanniiinfection presents a high mortality rate and few therapeutic options. This study aimed to evaluate clinical-microbiological characteristics and prognosis factors of patients diagnosed with A. baumanni. infections treated with oral doxycycline. A retrospective cohort of hospitalized patients with confirmed Acinetobacterspp. infection between 2018 and 2020 receives at least 3 days of oral doxycycline. Clinical and microbiological data were evaluated, including the outcome and molecular characterization of A. baumannii. Doxycycline minimal inhibitory concentrations were evaluated by the broth dilution method. One hundred patients were included with a median age of 51 years. The leading site of infection was pulmonary (n= 62), followed by the soft tissues and skin (n= 28). A. baumanniiresistant to carbapenem was found on 94%. The gene blaOXA-23 and blaOXA-51 were amplified in all recovered isolates of A. baumannii(n= 44). Doxycycline MIC50 and MIC90 were 1 µg/mL and 2 µg/mL, respectively. Death rate at 14 days and 28 days of follow-up was 9% and 14%, respectively. The prognostic factors related to death at end of follow-up were age > 49 years [85.7% vs.46%, CI 95% 6.9 (1.4–32.6), P= 0.015] and hemodialysis [28.6% vs.7%, CI 95% 5.33 (1.2–22.1), P= 0.021]. Patients treated with doxycycline to A. baumanniipresented a relatively low death rate, and risk factors related to death were age and hemodialysis. Further and larger studies should compare polymyxin to doxycycline to better understand the differences between these therapeutic options.
Databáze: Supplemental Index