Cefoperazone-sulbactam in cobination with meropenem versus colistin in combination with meropenem in treatment of ventilator – associated pneumonia, caused by carbapenem-resistant Acinetobacter baumannii
Introduction: It is well known, that one of the main microorganisms, which cause ventilator-associated pneumonia is carbapenem-resistant Acinetobacter baumannii. The aim of our investigation was to compare the results of treatment of patients with ventilator-associated pneumonia by providing two schemas of antibacterial therapy: colistin plus meropenem and cefoperazone-sulbactam plus meropenem. The infections, caused by carbapenem-resistant Acinetobacter baumannii present a great problem in treatment of nosocomial infections, because of high rate of morbidity and mortality among critically ill patients.
Aim of study: To compare the efficiency of two arms of final antibacterial therapy, which were based on colistin, cefoperazone-sulbactam and meropenem.
Matherials and methods: This investigation included 83 patients with ventilator-associated pneumonia, caused by carbapenem-resistant Acinetobacter baumannii. The patients were divided into two groups. The group of observation received the traditional combination of colistin plus meropenem; the investigation group received combination of cefoperazone-sulbactam plus meropenem.
Results: Among the patients with ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii the 28-th day mortality level in investigation group was significantly lower, than in observation group. Clinical cure in investigation group on 14-th and 28-th day was documented more frequently than in observation group.
Microbiologic failure in cefoperazone-sulbactam group was registrated 20,3 percents less often than in group with tradition treatment colistin + meropenem. The 28-th day RIFLE score-based kidney injury in investigation group was significantly lower, than in observation group.
It was estimated, that the use of colistin-based antibacterial therapy was a risk-factor, associated with all-cause mortality within 28 days. On contrast, the use of sulbactam-based antimicrobial therapy was associated with higher survival level on day 28.
Conclusion: Cefoperazone-sulbactam plus meropenem combination has more advantages in comparison with colistin plus meropenem combination among patients with ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii
Key words: Carbapenem-resistant Acinetobacter baumanni, colistin, cefoperazone – sulbactam, ventilator-associated pneumonia.
Authors:
- Zgrzheblovska Lesya Volodymyrivna, senior resident of the department of general intensive care, professor of the department of anesthesiology and intensive care of the P.L. Shupyk National Hospital for Emergency Care (work supervision, critical analysis).
- Malysh Ihor Rostyslavovych, head of the department of general intensive care of the Kyiv City Clinical Hospital for Emergency Care, professor of the department of anesthesiology and intensive care of the P.L. Shupyk National Hospital for Emergency Care (article design, scientific interest, participation in the treatment of patients).
- Berezenko Ivan Mykhailovych, deputy director of the surgical service of the Kyiv City Clinical Hospital for Emergency Care (data collection and analysis, writing of the article).
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