Clinical Outcomes of Patients Infected with Carbapenem-Resistant Acinetobacter Baumannii Treated with Single or Combination Antibiotic Therapy
Wichai Santimaleeworagun MPharm*, Payom Wongpoowarak PhD*, Pantip Chayakul MD**, Sutthiporn Pattharachayakul PharmD*, Pimpimon Tansakul PhD***, Kevin W Garey PharmD, MS****
Affiliation : * Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand ** Department of Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand *** Department of Pharmacognosy and Pharmaceutical Botany, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Songkhla, Thailand **** Department of Clinical Sciences and Administration, College of Pharmacy, University of Houston, Houston, Texas, USA
Objective : To evaluate treatment outcomes in patients with carbapenem-resistant Acinetobacter baumannii (CRAB) nosocomial
infections treated with antimicrobial agent either alone or in combination.
Material and Method: Clinical data were retrospectively evaluated in patients with CRAB nosocomial infections admitted to
Songklanagarind Hospital, Songkhla, Thailand from January-December 2008.
Results : One hundred ten patients with CRAB nosocomial infections were identified. Most patients (57.3%) had site of
infection in the lower respiratory tract and the majority of them (61.8%) received a single antimicrobial agent. Crude
mortality was 30%. The presumptive success rate was 60.3% (41/68) for patients given monotherapy and 81.0% (34/42) for
patients given combination therapy (p = 0.024). Patients given combination therapy were more likely to have been given at
least one antibiotic to which the organism was susceptible (p = 0.004). In multivariate analysis, renal impairment, bloodstream
infection, and inappropriate antimicrobial regimen were independent predictors of treatment failure.
Conclusion : The combination therapy regimen yielded more presumptive treatment success by increasing the likelihood of
an appropriate antimicrobial therapy. Additionally, inappropriate antimicrobial treatment, renal impairment, and bloodstream
infection were associated with poor treatment outcomes in patients with CRAB nosocomial infections.
Keywords : Clinical outcomes, Combination therapy, Fosfomycin, Carbapenem-resistant Acinetobacter baumannii
