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A retrospective analysis of carbapenem-resistant Acinetobacter baumannii-mediated nosocomial pneumonia and the in vitro therapeutic benefit of cefoperazone/sulbactam.
Int J Infect Dis 2014; 23:90-3IJ

Abstract

BACKGROUND

Acinetobacter baumannii has been reported increasingly as a significant causative organism of various nosocomial infections, including hospital-acquired pneumonia (HAP). The aim of this study was to investigate the clinical characteristics of HAP induced by carbapenem-resistant A. baumannii (CRAB) in elderly patients and the in vitro antimicrobial effects of cefoperazone/sulbactam combination therapy.

METHODS

Seventy-one elderly patients in the geriatric ward of the General Hospital of the People's Liberation Army (PLAGH) with CRAB-induced HAP were analyzed retrospectively. The checkerboard method was used to determine the in vitro drug sensitivity of 60 CRAB strains to antimicrobial combinations (cefoperazone/sulbactam with meropenem, minocycline, or levofloxacin). The occurrence of carbapenemase genes was detected by PCR.

RESULTS

CRAB-induced HAP occurred mostly in patients with underlying diseases. Prior to onset, most patients had received antimicrobial therapies including broad-spectrum β-lactams, invasive mechanical ventilation, and catheterization. The 30-day survival rate was 95.1% in patients using cefoperazone/sulbactam, with or without combination with antimicrobial drugs, and 73.3% in patients not using cefoperazone/sulbactam (p<0.05). When cefoperazone/sulbactam was used in combination with minocycline, levofloxacin, and meropenem, minimum inhibitory concentrations MIC50 and MIC90 were reduced for each drug. The genes OXA-23 and OXA-51 were amplified in 96.7% of the strains, but the genes OXA-24, OXA-58, SIM, VIM, and IMP were not amplified.

CONCLUSIONS

CRAB-induced HAP occurred mostly in patients with anemia or decreased levels of serum albumin, but with elevated levels of C-reactive protein and creatinine. Cefoperazone/sulbactam in combination with minocycline, meropenem, and levofloxacin had a synergistic and additive in vitro bacteriostatic action on CRAB.

Authors+Show Affiliations

Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China.Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China.Nanlou Clinical Laboratory Department, Chinese PLA General Hospital, Beijing, China.Nanlou Clinical Laboratory Department, Chinese PLA General Hospital, Beijing, China.Nanlou Clinical Laboratory Department, Chinese PLA General Hospital, Beijing, China.Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, China. Electronic address: fangxq301@126.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24726664

Citation

Xia, Jingjing, et al. "A Retrospective Analysis of Carbapenem-resistant Acinetobacter Baumannii-mediated Nosocomial Pneumonia and the in Vitro Therapeutic Benefit of Cefoperazone/sulbactam." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 23, 2014, pp. 90-3.
Xia J, Zhang D, Xu Y, et al. A retrospective analysis of carbapenem-resistant Acinetobacter baumannii-mediated nosocomial pneumonia and the in vitro therapeutic benefit of cefoperazone/sulbactam. Int J Infect Dis. 2014;23:90-3.
Xia, J., Zhang, D., Xu, Y., Gong, M., Zhou, Y., & Fang, X. (2014). A retrospective analysis of carbapenem-resistant Acinetobacter baumannii-mediated nosocomial pneumonia and the in vitro therapeutic benefit of cefoperazone/sulbactam. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 23, pp. 90-3. doi:10.1016/j.ijid.2014.01.017.
Xia J, et al. A Retrospective Analysis of Carbapenem-resistant Acinetobacter Baumannii-mediated Nosocomial Pneumonia and the in Vitro Therapeutic Benefit of Cefoperazone/sulbactam. Int J Infect Dis. 2014;23:90-3. PubMed PMID: 24726664.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A retrospective analysis of carbapenem-resistant Acinetobacter baumannii-mediated nosocomial pneumonia and the in vitro therapeutic benefit of cefoperazone/sulbactam. AU - Xia,Jingjing, AU - Zhang,Duchao, AU - Xu,Yaping, AU - Gong,Meiliang, AU - Zhou,Yu, AU - Fang,Xiangqun, Y1 - 2014/04/12/ PY - 2013/08/29/received PY - 2014/01/11/revised PY - 2014/01/14/accepted PY - 2014/4/15/entrez PY - 2014/4/15/pubmed PY - 2015/1/21/medline KW - Acinetobacter baumannii KW - Carbapenem KW - Combined drug sensitivity test KW - Hospital-acquired pneumonia SP - 90 EP - 3 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 23 N2 - BACKGROUND: Acinetobacter baumannii has been reported increasingly as a significant causative organism of various nosocomial infections, including hospital-acquired pneumonia (HAP). The aim of this study was to investigate the clinical characteristics of HAP induced by carbapenem-resistant A. baumannii (CRAB) in elderly patients and the in vitro antimicrobial effects of cefoperazone/sulbactam combination therapy. METHODS: Seventy-one elderly patients in the geriatric ward of the General Hospital of the People's Liberation Army (PLAGH) with CRAB-induced HAP were analyzed retrospectively. The checkerboard method was used to determine the in vitro drug sensitivity of 60 CRAB strains to antimicrobial combinations (cefoperazone/sulbactam with meropenem, minocycline, or levofloxacin). The occurrence of carbapenemase genes was detected by PCR. RESULTS: CRAB-induced HAP occurred mostly in patients with underlying diseases. Prior to onset, most patients had received antimicrobial therapies including broad-spectrum β-lactams, invasive mechanical ventilation, and catheterization. The 30-day survival rate was 95.1% in patients using cefoperazone/sulbactam, with or without combination with antimicrobial drugs, and 73.3% in patients not using cefoperazone/sulbactam (p<0.05). When cefoperazone/sulbactam was used in combination with minocycline, levofloxacin, and meropenem, minimum inhibitory concentrations MIC50 and MIC90 were reduced for each drug. The genes OXA-23 and OXA-51 were amplified in 96.7% of the strains, but the genes OXA-24, OXA-58, SIM, VIM, and IMP were not amplified. CONCLUSIONS: CRAB-induced HAP occurred mostly in patients with anemia or decreased levels of serum albumin, but with elevated levels of C-reactive protein and creatinine. Cefoperazone/sulbactam in combination with minocycline, meropenem, and levofloxacin had a synergistic and additive in vitro bacteriostatic action on CRAB. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/24726664/A_retrospective_analysis_of_carbapenem_resistant_Acinetobacter_baumannii_mediated_nosocomial_pneumonia_and_the_in_vitro_therapeutic_benefit_of_cefoperazone/sulbactam_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S1201-9712(14)00054-X DB - PRIME DP - Unbound Medicine ER -