Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial
Background: The current treatment recommendation involves administering a high dose of sulbactam alongside at least one additional agent. However, there remains a lack of data regarding the optimal dosage of sulbactam. We investigated whether administering sulbactam at a dosage of 12 g/day decreases...
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Elsevier
2024-12-01
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| Series: | International Journal of Infectious Diseases |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224003382 |
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| author | Chutchawan Ungthammakhun Vasin Vasikasin Waristha Simsiriporn Piraporn Juntanawiwat Dhitiwat Changpradub |
| author_facet | Chutchawan Ungthammakhun Vasin Vasikasin Waristha Simsiriporn Piraporn Juntanawiwat Dhitiwat Changpradub |
| author_sort | Chutchawan Ungthammakhun |
| collection | DOAJ |
| description | Background: The current treatment recommendation involves administering a high dose of sulbactam alongside at least one additional agent. However, there remains a lack of data regarding the optimal dosage of sulbactam. We investigated whether administering sulbactam at a dosage of 12 g/day decreases the mortality rate among patients with CRAB pneumonia compared to 9 g/day. Methods: The study was an open-label, superiority, randomized controlled trial conducted at Phramongkutklao Hospital between September 2019 and September 2023 in patients diagnosed with CRAB. Participants were randomly assigned to receive a combination of colistin with either 9 or 12 g/day of sulbactam. The primary endpoint was the all-cause mortality rate at 28 days postrandomization. Results: Among the 138 participants, there was a trend towards a lower mortality rate in the 12 g/day group (59.4% vs. 47.8%; P = 0.158). After adjusting for factors associated with mortality, a lower mortality was observed in the 12 g/day group (adjusted HR 0.54 [95% CI 0.33-0.87]; P = 0.0110). The microbiological cure rate at day 7 was higher in the 12 g/day group (73.2% vs. 89.4%; P = 0.02). Conclusions: Colistin in combination with sulbactam at a dosage of 12 g/day may improve mortality compared to 9 g/day. |
| format | Article |
| id | doaj-art-b6d8b3cd8d4f4ce98460d3a6e570b286 |
| institution | Kabale University |
| issn | 1201-9712 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj-art-b6d8b3cd8d4f4ce98460d3a6e570b2862024-11-29T06:23:10ZengElsevierInternational Journal of Infectious Diseases1201-97122024-12-01149107267Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trialChutchawan Ungthammakhun0Vasin Vasikasin1Waristha Simsiriporn2Piraporn Juntanawiwat3Dhitiwat Changpradub4Division of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok, ThailandDivision of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Hospital, London, United Kingdom; Corresponding author.Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, ThailandDivision of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, ThailandDivision of Infectious Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok, ThailandBackground: The current treatment recommendation involves administering a high dose of sulbactam alongside at least one additional agent. However, there remains a lack of data regarding the optimal dosage of sulbactam. We investigated whether administering sulbactam at a dosage of 12 g/day decreases the mortality rate among patients with CRAB pneumonia compared to 9 g/day. Methods: The study was an open-label, superiority, randomized controlled trial conducted at Phramongkutklao Hospital between September 2019 and September 2023 in patients diagnosed with CRAB. Participants were randomly assigned to receive a combination of colistin with either 9 or 12 g/day of sulbactam. The primary endpoint was the all-cause mortality rate at 28 days postrandomization. Results: Among the 138 participants, there was a trend towards a lower mortality rate in the 12 g/day group (59.4% vs. 47.8%; P = 0.158). After adjusting for factors associated with mortality, a lower mortality was observed in the 12 g/day group (adjusted HR 0.54 [95% CI 0.33-0.87]; P = 0.0110). The microbiological cure rate at day 7 was higher in the 12 g/day group (73.2% vs. 89.4%; P = 0.02). Conclusions: Colistin in combination with sulbactam at a dosage of 12 g/day may improve mortality compared to 9 g/day.http://www.sciencedirect.com/science/article/pii/S1201971224003382Carbapenems resistant Acinetobacter baumannii pneumoniaMortality rateSulbactam |
| spellingShingle | Chutchawan Ungthammakhun Vasin Vasikasin Waristha Simsiriporn Piraporn Juntanawiwat Dhitiwat Changpradub Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial International Journal of Infectious Diseases Carbapenems resistant Acinetobacter baumannii pneumonia Mortality rate Sulbactam |
| title | Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial |
| title_full | Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial |
| title_fullStr | Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial |
| title_full_unstemmed | Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial |
| title_short | Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: A randomized controlled trial |
| title_sort | effect of colistin combined with sulbactam 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant acinetobacter baumannii pneumonia a randomized controlled trial |
| topic | Carbapenems resistant Acinetobacter baumannii pneumonia Mortality rate Sulbactam |
| url | http://www.sciencedirect.com/science/article/pii/S1201971224003382 |
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