Efficacies of Colistin–Carbapenem versus Colistin–Tigecycline in Critically Ill Patients with CR-GNB-Associated Pneumonia: A Multicenter Observational Study
Sheng-Huei Wang,
Kuang-Yao Yang,
Chau-Chyun Sheu,
Wei-Cheng Chen,
Ming-Cheng Chan,
Jia-Yih Feng,
Chia-Min Chen,
Biing-Ru Wu,
Zhe-Rong Zheng,
Yu-Ching Chou,
Chung-Kan Peng,
on behalf of the T-CARE (Taiwan Critical Care Infection) Group
Affiliations
Sheng-Huei Wang
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
Kuang-Yao Yang
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
Chau-Chyun Sheu
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
Wei-Cheng Chen
Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
Ming-Cheng Chan
Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 407, Taiwan
Jia-Yih Feng
Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
Chia-Min Chen
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
Biing-Ru Wu
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
Zhe-Rong Zheng
Division of Pulmonary Medicine, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan
Yu-Ching Chou
School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
Chung-Kan Peng
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan
on behalf of the T-CARE (Taiwan Critical Care Infection) Group
Background: Evaluating the options for antibiotic treatment for carbapenem-resistant Gram-negative bacteria (CR-GNB)-associated pneumonia remains crucial. We compared the therapeutic efficacy and nephrotoxicity of two combination therapies, namely, colistin + carbapenem (CC) versus colistin + tigecycline (CT), for treating CR-GNB-related nosocomial pneumonia in critically ill patients. Methods: In this multicenter, retrospective, and cohort study, we recruited patients admitted to intensive care units and diagnosed with CR-GNB-associated nosocomial pneumonia. We divided the enrolled patients into CC (n = 62) and CT (n = 59) groups. After propensity score matching (n = 39), we compared the therapeutic efficacy by mortality, favorable outcome, and microbiological eradication and compared nephrotoxicity by acute kidney injury between groups. Results: There was no significant difference between the CC and CT groups regarding demographic characteristics and disease severities as assessed using the Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and other organ dysfunction variables. Therapeutic efficacy was non-significantly different between groups in all-cause mortality, favorable outcomes, and microbiological eradication at days 7, 14, and 28; as was the Kaplan-Meier analysis of 28-day survival. For nephrotoxicity, both groups had similar risks of developing acute kidney injury, evaluated using the Kidney Disease Improving Global Outcomes criteria (p = 1.000). Conclusions: Combination therapy with CC or CT had similar therapeutic efficacy and risk of developing acute kidney injury for treating CR-GNB-associated nosocomial pneumonia in critically ill patients.
