Intravenous Polymyxin B as Adjunctive Therapy to High-Dose Tigecycline for the Treatment of Nosocomial Pneumonia Due to Carbapenem-Resistant <i>Acinetobacter baumannii</i> and <i>Klebsiella pneumoniae</i>: A Propensity Score-Matched Cohort Study

Abstract

Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose tigecycline therapy in patients with pneumonia caused by carbapenem-resistant Klebsiella pneumoniae and Acinetobacter baumannii, we conducted a propensity score-matched cohort study in a single center between July 2019 and December 2021. Of the 162 eligible patients, 102 were included in the 1:1 matched cohort. The overall 14-day mortality in the matched cohort was 24.5%. Compared with high-dose tigecycline, the combination therapy was not associated with better clinical outcomes, and showed similar 14-day mortality (OR, 0.72, 95% CI 0.27–1.83, p = 0.486), clinical cure (OR, 1.09, 95% CI 0.48–2.54, p = 0.823), microbiological cure (OR, 0.96, 95% CI 0.39–2.53, p = 0.928) and rate of nephrotoxicity (OR 0.85, 95% CI 0.36–1.99, p = 0.712). Subgroup analyses also did not demonstrate any statistical differences. Based on these results, it is reasonable to recommend against adding polymyxin B to the high-dose tigecycline regimen in treating pneumonia caused by carbapenem-resistant K. pneumoniae and A. baumannii.

Keywords

• <i>Acinetobacter baumannii</i>
• carbapenem resistance
• <i>Klebsiella pneumoniae</i>
• nosocomial infection
• pneumonia
• polymyxin