The minimal inhibitory concentration for sulbactam was not associated
with the outcome of infections caused by carbapenem-resistant <i>Acinetobacter</i> sp.
treated with ampicillin/sulbactam

Oliveira, Maura S. de; Costa, Silvia Figueiredo; Pedri, Ewerton de; van der Heijden, Inneke; Levin, Anna Sara S.

doi:10.6061/clinics/2013(04)21

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Sumário

RAPID COMMUNICATION • Clinics 68 (4) • Apr 2013 • https://doi.org/10.6061/clinics/2013(04)21 copy

The minimal inhibitory concentration for sulbactam was not associated with the outcome of infections caused by carbapenem-resistant Acinetobacter sp. treated with ampicillin/sulbactam

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

The objective of this study was to evaluate whether the outcomes of carbapenem-resistant Acinetobacter infections treated with ampicillin/sulbactam were associated with the in vitro susceptibility profiles.

METHODS:

Twenty-two infections were treated with ampicillin/sulbactam. The median treatment duration was 14 days (range: 3-19 days), and the median daily dose was 9 g (range: 1.5-12 g). The median time between Acinetobacter isolation and treatment was 4 days (range: 0-11 days).

RESULTS:

The sulbactam minimal inhibitory concentration (MIC) ranged from 2.0 to 32.0 mg/L, and the MIC was not associated with patient outcome, as 4 of 5 (80%) patients with a resistant infection (MIC≥16), 5 of 10 (50%) patients with intermediate isolates (MIC of 8) and only 1 of 7 (14%) patients with susceptible isolates (MIC ≤4) survived hospitalization.

CONCLUSION:

These findings highlight the need to improve the correlation between in vitro susceptibility tests and clinical outcome.

Antimicrobial Susceptibility; Resistance; Treatment

Gender	Age (y)	Apache II score (points)	Underlying diseases	Mechanical ventilation	Urinary catheter	Central venous catheter	Acinetobacter infection	Daily ampicillin-sulbactam dose (g)	Highest creatinine level during treatment (mg/dl)	Treatment duration (days)	Days to initiate treatment	Clinical outcome	In- hospital death	Sulbactam MIC (mg/L)
M	55	19	Renal transplant	No	No	Yes	BSI	6	2.5	14	9	Success	No	2
M	59	9	Cancer of the larynx	Yes	Yes	Yes	BSI	3	5.3	15	4	Success	Yes	2
M	84	23	Stroke	Yes	Yes	Yes	Pneumonia	NA	1.6	15	7	Success	Yes	2
M	46	13	Burn	Yes	Yes	Yes	Pneumonia	12	0.6	14	5	Success	Yes	4
F	16	14	Acute abdomen	Yes	Yes	Yes	BSI	9	1.1	16	4	Success	No	4
F	74	15	Endometrial cancer	Yes	Yes	Yes	BSI	9	2.7	14	3	Success	Yes	4
M	63	13	Lymphoma	No	Yes	Yes	BSI	6	2,2	3	3	Failure	Yes	4
M	58	22	Cirrhosis and dialytic renal failure	Yes	Yes	Yes	BSI	6	3.6	10	4	Failure	Yes	8
M	23	18	Trauma	Yes	Yes	Yes	BSI	12	0.7	11	6	Success	No	8
M	70	19	Chronic obstructive pulmonary disease	Yes	Yes	Yes	BSI	3	3.8	14	2	Success	Yes	8
M	7	19	Burn	Yes	Yes	Yes	BSI	4	0.7	9	3	Failure	Yes	8
M	24	11	Leukemia	No	No	No	BSI	12	3.3	8	3	Failure	Yes	8
F	54	7	Breast cancer	No	No	Yes	BSI	12	NA	13	36	Success	No	8
M	56	NA	Acute abdomen	No	No	Yes	BSI	6	4.3	11	4	Failure	Yes	8
F	36	11	Hemangioblastoma	Yes	Yes	Yes	Pneumonia	12	0.6	15	5	Sucess	No	8
M	60	10	Stomach cancer	No	Yes	Yes	BSI	12	NA	3	4	Success	No	8
F	7	9	Heart failure	Yes	Yes	Yes	BSI	1.5	0.9 0.8	3	3	Failure	Yes	8
M	81	15	Heart failure	No	No	Yes	BSI	12	2.5	19	0	Success	No	16
F	23	18	Systemic erythematous lupus	Yes	Yes	Yes	BSI	3	4.4	16	11	Success	No	16
F	33	13	Kidney and pancreas transplant	No	Yes	Yes	Surgical site	3	2.5	14	5	Success	No	16
M	67	22	Multiple myeloma	No	No	Yes	BSI	12	NA	10	1	Failure	Yes	16
F	61	17	Leukemia	No	Yes	Yes	BSI	9	1.6	15	1	Success	No	16

	In-hospital mortality				Mortality during treatment
	Non-survivors (n = 12)	Survivors (n = 10)	RR (95% CI)	p	Death during treatment (n = 7)	Survivors until the end of treatment (n = 15)	RR (95% CI)	p
Age (years)
Mean (SD)	56.3 (21.6)	44.2 (21)		0.11	48.9 (23.7)	51.7 (21.6)		0.97
Median (range)	61 (7-84)	45 (16-81)			58 (7-67)	55 (16-84)
Male gender (%)	10	4	2.86 (0.82-9.92)	0.04	6	8	3.42 (0.49-23.6)	0.15
APACHE II score (points)				0.44				0.64
Mean (SD)	15.9 (5.3)	14.2 (4.0)			16(5.7)	14.7 (4.4)
Median (range)	15 (9-23)	14.5 (7-19)			16 (9-22)	15 (7-23)
Admission to ICU (%)	10	4	2.86 (0.82-9.92)	0.04	5	9	1.43(0.35- 5.74)	0.61
Acinetobacter infection site (n)				0.50
Bloodstream infection	10	8			7	11		0.32
Pneumonia	2	1			0	3
Surgical site infection	0	1			0	1
Time between isolation and beginning of treatment (days)				0.10				0.06
Mean (SD)	3.5 (1.5)	5.1 (3.2)			3.0 (1.0)	4.8 (2.9)
Median (range)	3 (1-7)	5 (0-11)			3 (1-4)	5 (0-11)
Daily Dose (grams)					6.8 (3.9)	9.6 (3.7)		0.21
Mean (SD)	6.7 (3.9)	9.0 (3.7)		0.21
Median (range)	6 (1.5-12)	10.5 (3-12)			6 (1.5-12)	10.5 (3-12)
Simultaneous use of carbapenem(n)	6	2	1.75(0.85-3.61)	0.15	3	5	1.31(0.39-4.44)	0.66
MIC (mg/L)				0.19				0.24
≤ 4	5	2			1	6
8	6	4			5	5
≥16	1	4			1	4

Faculdade de Medicina / USP Rua Dr Ovídio Pires de Campos, 225 - 6 and., 05403-010 São Paulo SP - Brazil, Tel.: (55 11) 2661-6235 - São Paulo - SP - Brazil
E-mail: clinics@hc.fm.usp.br

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[1] Oliveira MS reviewed the medical records, helped writing the manuscript and performed the data analysis. Costa SF performed the data analysis, supervised the experiments and helped writing the manuscript. De Pedri EH performed the experiments. van der Heijden IM performed the experiments and helped writing the manuscript. Levin AS analyzed the data, contributed to the study design and helped writing the manuscript.