Outcomes of Adjunctive Therapy with Intravenous Cefoperazone-Sulbactam for Ventilator-Associated Pneumonia Due to Carbapenem-Resistant Acinetobacter baumannii

Siripen Kanchanasuwan; Narongdet Kositpantawong; Kamonnut Singkhamanan; Thanaporn Hortiwakul; Boonsri Charoenmak; Nwabor Ozioma F; Yohei Doi; Sarunyou Chusri

doi:10.2147/IDR.S305819

Outcomes of Adjunctive Therapy with Intravenous Cefoperazone-Sulbactam for Ventilator-Associated Pneumonia Due to Carbapenem-Resistant Acinetobacter baumannii

Infect Drug Resist. 2021 Mar 29:14:1255-1264. doi: 10.2147/IDR.S305819. eCollection 2021.

Authors

Siripen Kanchanasuwan¹, Narongdet Kositpantawong¹, Kamonnut Singkhamanan², Thanaporn Hortiwakul¹, Boonsri Charoenmak¹, Nwabor Ozioma F^{1

3}, Yohei Doi^{4

5}, Sarunyou Chusri^{1

2}

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
² Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
³ Excellence Research Laboratory on Natural Products, Division of Biological Science, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand.
⁴ Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁵ Department of Microbiology, Fujita Health University, Aichi, Japan.

Abstract

Introduction: The efficacy of adjunctive therapy with cefoperazone-sulbactam (CEP-SUL) for ventilator-associated pneumonia (VAP) due to carbapenem-resistant A. baumannii (CRAB) is unclear.

Methods: We retrospectively analyzed the therapeutic effect of adding CEP-SUL to standard regimens for VAP due to CRAB. Patients with VAP due to CRAB strains that were susceptible to CEP-SUL were enrolled into the study. The patients were divided into two groups: those who receive cefoperazone-sulbactam (CEP-SUL⁺), and those who did not receive cefoperazone-sulbactam (CEP-SUL). Mortality rates and resource utilization of these two groups were compared. Factors associated with mortality were explored.

Results: Eighty patients were enrolled into the study, 52 CEP-SUL⁺ and 28 CEP-SUL^-. The baseline characteristics of the two groups were comparable, except for median Acute Physiology and Chronic Health Evaluation (APACHE) II score which was significantly higher for CEP-SUL⁺. Thirty-day, and in-hospital mortality rates for CEP-SUL⁺ were significantly lower than CEP-SUL^- with values of 35%, 39% and 61%, 68%, for CEP-SUL⁺ and CEP-SUL^-, respectively. The survival rate for CEP-SUL⁺ was significantly higher compared with CEP-SUL^- (P < 0.001). The number of hospital days, ventilator days since diagnosis of VAP and hospital costs were lower for CEP-SUL⁺.

Conclusion: Overall results suggested that patients with VAP due to CRAB strains who received adjunctive therapy with CEP-SUL had lower mortality rates and resource utilization compared with CEP-SUL^-.

Keywords: carbapenem-resistant Acinetobacter baumannii; cefoperazone-sulbactam; outcome; ventilator-associated pneumonia.