5 years ago

The Combined Use of Tigecycline with High-Dose Colistin Might Not be Associated With Higher Survival in Critically ill Patients With Bacteraemia Due to Carbapenem-Resistant Acinetobacter Baumannii

To assess the association of survival and treatment with colistin and tigecycline in critically ill patients with carbapenem-resistant A. baumannii bacteraemia. Methods An observational cohort study was carried out. Targeted therapy consisted of monotherapy with colistin (9 millions UI/day) or combined therapy with colistin and tigecycline (100 g/day). The primary outcome was 30-day crude mortality. The association between combined targeted therapy and mortality was controlled for empirical therapy with colistin, propensity score of combined therapy and other potential confounding variables in a multivariate Cox regression analysis. Results A total of 118 cases were analysed. Seventy-six patients (64%) received monotherapy and 42 patients (36%) received combined therapy. The source of bacteraemia was primary in 18% (21/118) of the patients, ventilator-associated pneumonia in 64% (76/118) and other sources in 14% (16/118). The 30-day crude mortality rate was 62% (42/76) for monotherapy and 57% (24/42) for combined therapy. The variables associated with 30-day crude mortality were: Charlson index (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.02–1.32; p = .028), empirical therapy with colistin (HR 2.25, 95% CI 1.33–3.80; p = .003) and renal dysfunction prior to treatment (HR 1.91, 95% CI 1.01-3.61; p =.045). Combined targeted therapy was not associated with lower adjusted 30-day crude mortality (adjusted HR 1.29, 95% CI 0.64–2.58; p = .494). Conclusions Combined targeted therapy with high-dose colistin and standard dose tigecycline was not associated with lower crude mortality of bacteraemia due to carbapenem-resistant A. baumannii in critically ill patients. Trial registration Registered in ClinicalTrials.gov. Identifier: NCT02573064.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17305293

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