Acute and Critical Care

Original Article

Infection
High-dose Sulbactam Treatment for Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Acinetobacter Baumannii: In Beom Jeong, Moon Jun Na, Ji Woong Son, Do Yeon Jo, Sun Jung Kwon; Korean J Crit Care Med. 2016;31(4):308-316. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2015.00703

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Background
Several antibiotics can be used to treat ventilator-associated pneumonia caused by carbapenem-resistant A. baumannii (CRAB-VAP) including high-dose sulbactam. However, the effectiveness of high-dose sulbactam therapy is not well known. We report our experience with high-dose sulbactam for treatment of CRAB-VAP.
Methods
Medical records of patients with CRAB-VAP who were given high-dose sulbactam between May 2013 and June 2015 were reviewed.
Results
Fifty-eight patients with CRAB-VAP were treated with high-dose sulbactam. The mean age was 72.0 ± 15.2 years, and the acute physiology and chronic health evaluation II (APACHE II) score was 15.1 ± 5.10 at the time of CRAB-VAP diagnosis. Early clinical improvement was observed in 65.5% of patients, and 30-day mortality was 29.3%. Early clinical failure (odds ratio [OR]: 8.720, confidence interval [CI]: 1.346-56.484; p = 0.023) and APACHE II score ≥ 14 at CRAB-VAP diagnosis (OR: 10.934, CI: 1.047-114.148; p = 0.046) were associated with 30-day mortality.
Conclusions
High-dose sulbactam therapy may be effective for the treatment of CRAB-VAP. However, early clinical failure was observed in 35% of patients and was associated with poor outcome.

Citations

Citations to this article as recorded by

A Randomized Controlled Trial of Colistin Combined with Sulbactam: 9 g per Day versus 12 g per Day in the Treatment of Extensively Drug-Resistant Acinetobacter baumannii Pneumonia: An Interim Analysis
Chutchawan Ungthammakhun, Vasin Vasikasin, Dhitiwat Changpradub
Antibiotics.2022; 11(8): 1112. CrossRef
Meropenem/colistin versus meropenem/ampicillin–sulbactam in the treatment of carbapenem-resistant pneumonia
Hossein Khalili, Lida Shojaei, Mostafa Mohammadi, Mohammad-Taghi Beigmohammadi, Alireza Abdollahi, Mahsa Doomanlou
Journal of Comparative Effectiveness Research.2018; 7(9): 901. CrossRef

Case Report

Infection/Pulmonary
Lung Transplantation in a Patient with Pre-transplant Colonization of Extensively Drug-resistant Acinetobacter baumannii: Hwa Young Lee, Hea Yon Lee, Sae Bom Shin, Kab Soo Shin, Bong Woo Lee, Hwan Wook Kim, Seok Lee, Seok Chan Kim; Korean J Crit Care Med. 2015;30(2):103-108. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.103

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Abstract PDF: Colonization of the pre-transplant lung by multidrug-resistant bacteria affects short- and long-term outcomes of lung transplantation. However, there are no case reports on the colonization of a pre-transplant lung by drug-resistant Acinetobacter baumannii. We report a case of extensively drug resistant (XDR) A. baumannii colonization in the tracheobronchial tree that caused severe infectious complications after bilateral lung transplantation. A 23-year-old man diagnosed with bronchiolitis obliterans syndrome (BOS) 4 years earlier with a history of allogenic bone marrow transplantation for acute lymphoblastic leukemia was admitted to the hospital with dyspnea. Due to progressive hypercapnic respiratory failure, long-term mechanical ventilation was started after a tracheostomy was performed, and the patient underwent a bilateral lung transplantation to treat end-stage BOS. After the transplantation, the colonization of XDR A. baumannii caused severe bacterial pneumonia in the early postoperative period. Combined treatment with colistin and meropenem led to recovery from the pneumonia but caused drug-induced renal failure. Because many centers are willing to transplant candidates who are on mechanical ventilation or extracorporeal life support, the incidence of XDR A. baumannii colonization of pretransplant lungs is expected to increase. Further studies are needed to examine pre-transplant management strategies in patients colonized with XDR A. baumannii.

Original Article

Clinical Characteristics in Patients with Carbapenem-Resistant Acinetobacter baumannii Isolates from Tracheal Secretions: Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye Kyung Park, Min Ki Lee; Korean J Crit Care Med. 2013;28(3):173-179.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.173

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Abstract PDF: BACKGROUND
This study was conducted to evaluate the clinical characteristics and outcomes of mechanically ventilated patients with carbapenem-resistant Acinetobacter baumannii (CRAB) isolates from tracheal secretions in a medical intensive care unit (ICU) of a university hospital.
METHODS
We conducted a retrospective study from January 2009 to June 2012.
RESULTS
Among the patients who had isolates cultured from tracheal secretions, 130 patients (34.8%) had CRAB isolates. Their mean age was 65 +/- 14 yr and 74.6% were male. The ICU and hospital mortality was 51.5% and 60.0%, respectively. According to physician's clinical decision, antibiotics were changed in order to cover CRAB in 75 (57.7%) patients. The total duration of antibiotics use was 12.2 +/- 8.1 days. Of patients with antibiotics change to cover CRAB, 70 patients (93.3%) had Clinical Pulmonary Infection Score of 6 and over. However, there was no significant difference in hospital mortality between patients with antibiotics change against CRAB and those without change. In multivariable analysis, only Acute Physiology and Chronic Health Evaluation II score was related to hospital mortality of patients with CRAB.
CONCLUSIONS
In this study, changing antibiotics to cover CRAB by physician's clinical decision only did not influence hospital mortality; further studies would be necessary to investigate how to use antibiotics against CRAB isolates cultured from tracheal secretions.

Case Report

Extreme Drug Resistant Acinetobacter Nosocomial Ventilator-Associated Pneumonia Treated Successfully with Tigecycline and Amikacin in Intensive Care Unit: A Case Report: So Yeon Lim, So Young Park, Kyeongman Jeon, Gee Young Suh, Suhyun Kim, Kyong Ran Peck, Doo Ryeon Chung; Korean J Crit Care Med. 2009;24(3):176-180.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.176

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Abstract PDF

Infections due to multidrug resistant Acinetobacter baumannii have become a challenging problem in intensive care units. Tigecycline is a derivative of minocyline, and has provided new hope for the treatment of multidrug-resistant A. baumannii infections. Because isolates showing reduced susceptibility to minocycline or tigecycline have emerged in many countries, empirical combination therapy has become common practice to treat patients infected with extreme drug-resistant A. baumannii. Herein we report a case of extreme drug-resistant A. baumannii infection successfully treated with tigecycline and amikacin.

Citations

Citations to this article as recorded by

Clinical Characteristics in Patients with Carbapenem-ResistantAcinetobacter baumanniiIsolates from Tracheal Secretions
Jeong Ha Mok, Mi Hyun Kim, Kwangha Lee, Ki Uk Kim, Hye-Kyung Park, Min Ki Lee
Korean Journal of Critical Care Medicine.2013; 28(3): 173. CrossRef

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