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. 2024 Nov;13(11):2351-2362.
doi: 10.1007/s40121-024-01042-w. Epub 2024 Sep 25.

Combination Versus Monotherapy for Carbapenem-Resistant Acinetobacter Species Serious Infections: A Prospective IPTW Adjusted Cohort Study

Abi Manesh  1 , Mithun Mohan George  2 , Prasannakumar Palanikumar  2 , V Nagaraj  2 , Kundakarla Bhanuprasad  2 , Ramya Krishnan  2 , G Nivetha  2 , Binesh Lal  3 , K Rajitha Triveni  4 , Priyanka Gautam  2 , Biju George  5 , Uday Kulkarni  5 , Vikram Mathews  5 , K Subramani  6 , Shoma Rao  6 , Binila Chacko  6 , Anand Zachariah  7 , Sowmya Sathyendra  7 , Samuel George Hansdak  7 , Ooriapadickal Cherian Abraham  7 , Ramya Iyadurai  7 , Rajiv Karthik  2 , John Victor Peter  6 , Yin Mo  8   9   10   11 , Balaji Veeraraghavan  3 , George M Varghese  2 , David Leslie Paterson  11   12
Affiliations

Combination Versus Monotherapy for Carbapenem-Resistant Acinetobacter Species Serious Infections: A Prospective IPTW Adjusted Cohort Study

Abi Manesh et al. Infect Dis Ther. 2024 Nov.

Abstract

Introduction: International guidelines recommend definitive combination antibiotic therapy for the management of serious infections involving carbapenem-resistant Acinetobacter (CRAB) species. The commonly available combination options include high-dose sulbactam, polymyxins, tetracyclines, and cefiderocol. Scanty prospective data exist to support this approach.

Methods: Patients with CRAB bacteraemia, ventilator-associated pneumonia (VAP), or both were categorized based on whether they received combination therapy or monotherapy. The 30-day mortality was compared between the two groups. Inverse probability treatment weighting (IPTW) was done using propensity score (PS) for a balanced comparison between groups.

Results: Between January 2021 and May 2023, of the 161 patients with CRAB bacteraemia (n = 55, 34.2%), VAP (n = 46, 28.6%), or both (n = 60, 37.3%) who received appropriate intravenous antibiotic therapy, 70% (112/161) received monotherapy, and the rest received combination therapy. The overall 30-day mortality was 62% (99/161) and not different (p = 0.76) between the combination therapy (31/49, 63.3%) and monotherapy (68/112, 60.7%) groups. The propensity score matching using IPTW did not show a statistical difference (p = 0.47) in 30-day mortality for receiving combination therapy with an adjusted odds ratio (OR) P of 1.29 (0.64, 2.58).

Conclusion: Combination therapy for CRAB infections needs further study in a randomised controlled trial, as this observational study showed no difference in 30-day mortality between monotherapy and combination therapy.

Keywords: Acinetobacter; CRAB infections; Combination therapy; Polymyxins.

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Conflict of interest statement

Abi Manesh, Mithun Mohan George, Prasannakumar Palanikumar, V Nagaraj, Kundakarla Bhanuprasad, Ramya Krishnan, Nivetha G, Binesh Lal, Rajitha Triveni K, Priyanka Gautam, Biju George, Uday Kulkarni, Vikram Mathews, K Subramani, Shoma Rao, Binila Chacko, Anand Zachariah, Sowmya Sathyendra, Samuel George Hansdak, Ooriapadickal Cherian Abraham, Ramya Iyadurai, Rajiv Karthik, John Victor Peter, Yin Mo, George M Varghese, and David Leslie Paterson declare no conflict of interest. Balaji Veeraraghavan is an Editorial Board member of Infectious Diseases and Therapy. Balaji Veeraraghavan was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions.

Figures

Fig. 1
Fig. 1
Distribution of various combination therapies received by the study participants. Others include CAZ AVI (5), tigecycline + sulbactam (4), and minocycline + sulbactam (2)
See this image and copyright information in PMC

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