J Med Assoc Thai 2017; 100 (7):740

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MIC and Synergy Testing Guide Antimicrobial Treatment of Ventilator-Associated Pneumonia due to Carbapenem-Resistant Acinetobacter baumannii
Sitaruno S Mail, Jaruratanasirikul S , Pattharachayakul S , Ingviya N , Hortiwakul T , Santimaleeworagun W , Khwannimit B

Background: The studies regarding the use of information from in vitro study to guide antimicrobial combination therapy in
clinical settings are limited.
Objective: To determine feasibility and impact of the application of MIC and synergy testing to guide antimicrobial therapy in
clinical setting.
Material and Method: Patients with ventilator-associated pneumonia (VAP) due to carbapenem-resistant A. baumannii
(CRAB) infections were enrolled. Susceptibility information obtained from disk diffusion, MIC determination, and synergy
testing with E-test method was used to select antimicrobial agent to combine with colistin. Treatment outcomes were assessed following antimicrobial treatment.
Results: Ten VAP-patients with CRAB infections were enrolled. Seven patients received non-active CRAB regimen as empirical
therapy. The results from disk diffusion, MIC determination, and synergy testing enabled the clinicians to choose regimen with
potential to be successful in 70%, 30%, and 20%, respectively. Finally, nine patients received colistin-sulbactam and one patient received colistin-imipenem. Favorable clinical and microbiological outcomes were observed in nine and six out of 10 patients, respectively.
Conclusion: The information from MIC determination and synergy testing by E-test method enables optimization of treatment regimens for VAP-patients with CRAB infections. This strategy revealed favorable treatment outcomes and that it is feasible to perform in clinical setting.

Keywords: Acinetobacter baumannii, CRAB, MIC determination, Synergy testing, Combination therapy, Colistin, Carbapenems, Sulbactam


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