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Randomized Controlled Trial
. 2019 Aug 16;69(5):769-776.
doi: 10.1093/cid/ciy988.

Treatment Outcomes of Colistin- and Carbapenem-resistant Acinetobacter baumannii Infections: An Exploratory Subgroup Analysis of a Randomized Clinical Trial

Yaakov Dickstein  1 , Jonathan Lellouche  1   2 , Maayan Ben Dalak Amar  1   2 , David Schwartz  1   2 , Amir Nutman  1   3 , Vered Daitch  3   4 , Dafna Yahav  3   5 , Leonard Leibovici  3   4 , Anna Skiada  6   7 , Anastasia Antoniadou  7   8 , George L Daikos  6   7 , Roberto Andini  9 , Rosa Zampino  9 , Emanuele Durante-Mangoni  9 , Johan W Mouton  10 , Lena E Friberg  11 , Yael Dishon Benattar  12   13 , Roni Bitterman  12 , Ami Neuberger  12 , Yehuda Carmeli  1   2   3 , Mical Paul  12   14 ; AIDA Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Treatment Outcomes of Colistin- and Carbapenem-resistant Acinetobacter baumannii Infections: An Exploratory Subgroup Analysis of a Randomized Clinical Trial

Yaakov Dickstein et al. Clin Infect Dis. .

Abstract

Background: We evaluated the association between mortality and colistin resistance in Acinetobacter baumannii infections and the interaction with antibiotic therapy.

Methods: This is a secondary analysis of a randomized controlled trial of patients with carbapenem-resistant gram-negative bacterial infections treated with colistin or colistin-meropenem combination. We evaluated patients with infection caused by carbapenem-resistant A. baumannii (CRAB) identified as colistin susceptible (CoS) at the time of treatment and compared patients in which the isolate was confirmed as CoS with those whose isolates were retrospectively identified as colistin resistant (CoR) when tested by broth microdilution (BMD). The primary outcome was 28-day mortality.

Results: Data were available for 266 patients (214 CoS and 52 CoR isolates). Patients with CoR isolates had higher baseline functional capacity and lower rates of mechanical ventilation than patients with CoS isolates. All-cause 28-day mortality was 42.3% (22/52) among patients with CoR strains and 52.8% (113/214) among patients with CoS isolates (P = .174). After adjusting for variables associated with mortality, the mortality rate was lower among patients with CoR isolates (odds ratio [OR], 0.285 [95% confidence interval {CI}, .118-.686]). This difference was associated with treatment arm: Mortality rates among patients with CoR isolates were higher in those randomized to colistin-meropenem combination therapy compared to colistin monotherapy (OR, 3.065 [95% CI, 1.021-9.202]).

Conclusions: Colistin resistance determined by BMD was associated with lower mortality among patients with severe CRAB infections. Among patients with CoR isolates, colistin monotherapy was associated with a better outcome compared to colistin-meropenem combination therapy.

Clinical trials registration: NCT01732250.

Keywords: Acinetobacter; XDR-TB; carbapenem-resistant; colistin; gram-negative bacteria.

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Comment in

  • Reply to Wilson et al.
    Dickstein Y, Leibovici L, Carmeli Y, Daikos G, Durante-Mangoni E, Friberg LE, Paul M. Dickstein Y, et al. Clin Infect Dis. 2020 Aug 22;71(5):1358-1359. doi: 10.1093/cid/ciz1100. Clin Infect Dis. 2020. PMID: 31734694 No abstract available.
  • Acinetobacter Infections.
    Wilson BM, Perez F, Pan Q, Jiang Y, Evans SR, Bonomo RA. Wilson BM, et al. Clin Infect Dis. 2020 Aug 22;71(5):1357-1358. doi: 10.1093/cid/ciz1099. Clin Infect Dis. 2020. PMID: 31734703 No abstract available.

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