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. 2021 Mar 8;10(3):271.
doi: 10.3390/antibiotics10030271.

Effect of N-Acetylcysteine Administration on 30-Day Mortality in Critically Ill Patients with Septic Shock Caused by Carbapenem-Resistant Klebsiella pneumoniae and Acinetobacter baumannii: A Retrospective Case-Control Study

Alessandra Oliva  1   2 , Alessandro Bianchi  1 , Alessandro Russo  1 , Giancarlo Ceccarelli  1 , Francesca Cancelli  1 , Fulvio Aloj  2 , Danilo Alunni Fegatelli  3 , Claudio Maria Mastroianni  1 , Mario Venditti  1
Affiliations

Effect of N-Acetylcysteine Administration on 30-Day Mortality in Critically Ill Patients with Septic Shock Caused by Carbapenem-Resistant Klebsiella pneumoniae and Acinetobacter baumannii: A Retrospective Case-Control Study

Alessandra Oliva et al. Antibiotics (Basel). .

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) and Acinetobacter baumannii (CR-Ab) represent important cause of severe infections in intensive care unit (ICU) patients. N-Acetylcysteine (NAC) is a mucolytic agent with antioxidant and anti-inflammatory properties, showing also in-vitro antibacterial activity. Aim was to evaluate the effect on 30-day mortality of the addition of intravenous NAC to antibiotics in ICU patients with CR-Kp or CR-Ab septic shock. A retrospective, observational case:control study (1:2) in patients with septic shock caused by CR-Kp or CR-Ab hospitalized in two different ICUs was conducted. Cases included patients receiving NAC plus antimicrobials, controls included patients not receiving NAC. Cases and controls were matched for age, SAPS II, causative agent and source of infection. No differences in age, sex, SAPS II score or time to initiate definitive therapy were observed between cases and controls. Pneumonia and bacteremia were the leading infections. Overall, mortality was 48.9% (33.3% vs. 56.7% in cases and controls, p = 0.05). Independent risk factors for mortality were not receiving NAC (p = 0.002) and CR-Ab (p = 0.034) whereas therapy with two in-vitro active antibiotics (p = 0.014) and time to initial definite therapy (p = 0.026) were protective. NAC plus antibiotics might reduce the 30-day mortality rate in ICU patients with CR-Kp and CR-Ab septic shock.

Keywords: N-acetylcysteine; carbapenem-resistant Acinetobacter baumannii; carbapenem-resistant Klebsiella pneumoniae; critically ill patients; septic shock.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow-chart of the study.
Figure 2
Figure 2
Overall 30-day survival rate in patients with carbapenem-resistant K. pneumoniae or A. baumannii septic shock receiving antibiotics plus intravenous NAC (cases, n = 30) or antibiotics only (controls, n = 60).
See this image and copyright information in PMC

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