Combination Versus Monotherapy for Carbapenem-Resistant Acinetobacter Species Serious Infections: A Prospective IPTW Adjusted Cohort Study.

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Infectious Diseases and Therapy Pub Date : 2024-11-01 Epub Date: 2024-09-25 DOI:10.1007/s40121-024-01042-w

Abi Manesh, Mithun Mohan George, Prasannakumar Palanikumar, V Nagaraj, Kundakarla Bhanuprasad, Ramya Krishnan, G Nivetha, Binesh Lal, K Rajitha Triveni, Priyanka Gautam, Biju George, Uday Kulkarni, Vikram Mathews, K Subramani, Shoma Rao, Binila Chacko, Anand Zachariah, Sowmya Sathyendra, Samuel George Hansdak, Ooriapadickal Cherian Abraham, Ramya Iyadurai, Rajiv Karthik, John Victor Peter, Yin Mo, Balaji Veeraraghavan, George M Varghese, David Leslie Paterson

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引用次数: 0

Abstract

Introduction: International guidelines recommend definitive combination antibiotic therapy for the management of serious infections involving carbapenem-resistant Acinetobacter (CRAB) species. The commonly available combination options include high-dose sulbactam, polymyxins, tetracyclines, and cefiderocol. Scanty prospective data exist to support this approach.

Methods: Patients with CRAB bacteraemia, ventilator-associated pneumonia (VAP), or both were categorized based on whether they received combination therapy or monotherapy. The 30-day mortality was compared between the two groups. Inverse probability treatment weighting (IPTW) was done using propensity score (PS) for a balanced comparison between groups.

Results: Between January 2021 and May 2023, of the 161 patients with CRAB bacteraemia (n = 55, 34.2%), VAP (n = 46, 28.6%), or both (n = 60, 37.3%) who received appropriate intravenous antibiotic therapy, 70% (112/161) received monotherapy, and the rest received combination therapy. The overall 30-day mortality was 62% (99/161) and not different (p = 0.76) between the combination therapy (31/49, 63.3%) and monotherapy (68/112, 60.7%) groups. The propensity score matching using IPTW did not show a statistical difference (p = 0.47) in 30-day mortality for receiving combination therapy with an adjusted odds ratio (OR) P of 1.29 (0.64, 2.58).

Conclusion: Combination therapy for CRAB infections needs further study in a randomised controlled trial, as this observational study showed no difference in 30-day mortality between monotherapy and combination therapy.

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耐碳青霉烯类杆菌严重感染的联合疗法与单一疗法：一项前瞻性 IPTW 调整队列研究。

导言：国际指南建议，在治疗耐碳青霉烯类杆菌（CRAB）引起的严重感染时，应采用明确的联合抗生素疗法。常用的联合疗法包括大剂量舒巴坦、多粘菌素、四环素和头孢克肟。支持这种方法的前瞻性数据很少：根据患者接受的是联合疗法还是单一疗法，对患有 CRAB 菌血症、呼吸机相关性肺炎（VAP）或两者兼有的患者进行分类。比较两组患者的 30 天死亡率。使用倾向得分（PS）进行逆概率治疗加权（IPTW），以实现组间平衡比较：2021年1月至2023年5月期间，161名患有CRAB菌血症（n = 55，34.2%）、VAP（n = 46，28.6%）或两者兼有（n = 60，37.3%）的患者接受了适当的静脉注射抗生素治疗，其中70%（112/161）接受了单一疗法，其余接受了联合疗法。综合疗法组（31/49，63.3%）和单一疗法组（68/112，60.7%）的 30 天总死亡率为 62%（99/161），无差异（p = 0.76）。使用IPTW进行倾向评分匹配，结果显示接受联合疗法的患者30天死亡率没有统计学差异（P = 0.47），调整后的比值比（OR）P为1.29（0.64，2.58）：结论：CRAB 感染的联合疗法需要在随机对照试验中进一步研究，因为这项观察性研究显示，单一疗法和联合疗法的 30 天死亡率没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infectious Diseases and Therapy Medicine-Microbiology (medical)

CiteScore

8.60

自引率

1.90%

发文量

136

审稿时长

6 weeks

期刊介绍： Infectious Diseases and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of infectious disease therapies and interventions, including vaccines and devices. Studies relating to diagnostic products and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, bacterial and fungal infections, viral infections (including HIV/AIDS and hepatitis), parasitological diseases, tuberculosis and other mycobacterial diseases, vaccinations and other interventions, and drug-resistance, chronic infections, epidemiology and tropical, emergent, pediatric, dermal and sexually-transmitted diseases.