Comparison of the efficacies of three empirically-selected antibiotics for treating Acinetobacter baumannii pulmonary infection: experience from a teaching hospital in China

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OBJECTIVE: Infections due to multidrug- and extensively drug-resistant forms of Acinetobacter baumannii (MDR-AB and XDR-AB, respectively) have become increasingly prevalent. This retrospective study compared the outcomes of patients infected with MDR-AB or XDR-AB and treated with one of three antibiotics.

METHODS: Enrolled were patients with MDR-AB or XDR-AB pulmonary infection based on their first sputum culture. Patients were treated empirically with carbapenems (n = 46), tigecycline (n = 25), or cefoperazone/sulbactam (cefina-SB; n = 35). The therapeutic efficacies of the drugs and patient outcomes were retrospectively compared. Bacterial resistance to the three antibacterials was determined based on sputum cultures from all enrolled patients.

RESULTS: The study included 106 patients. After 7 days of treatment, the favorable response rates to tigecycline (60%) and to cefina-SB (71.4%) were statistically similar (p = 0.355) but significantly higher than that to carbapenems (23.9%; p = 0.003 and p < 0.001, respectively). Sputum culture analyses to determine antibiotic susceptibility indicated that 10.4% of patients' sputum cultures were susceptible to carbapenems, 76.4% to tigecycline, and 66.0% to cefina-SB. In addition, 58.5% were susceptible to both tigecycline and cefina-SB.

CONCLUSIONS: Tigecycline and cefina-SB appeared to be more effective against MDR-AB and XDR-AB pulmonary infections than carbapenems, especially for patients who had been admitted to the intensive care unit multiple times.
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