Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients
Abstract Background Multidrug-resistant Acinetobacter baumannii emerged as a threatening “superbug” with significant morbidity and mortality and limited antimicrobial therapy options. The results of different antibiotic combination studies are heterogeneous and controversial. Further comparative stu...
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2025-03-01
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| author | Marwan J. Alwazzeh Jumanah Algazaq Fatimah Ali Al-Salem Fatimah Alabkari Sara M. Alwarthan Mashael Alhajri Bashayer M. AlShehail Amani Alnimr Ahmad Wajeeh Alrefaai Faten Hussain Alsaihati Fahd Abdulaziz Almuhanna |
| author_facet | Marwan J. Alwazzeh Jumanah Algazaq Fatimah Ali Al-Salem Fatimah Alabkari Sara M. Alwarthan Mashael Alhajri Bashayer M. AlShehail Amani Alnimr Ahmad Wajeeh Alrefaai Faten Hussain Alsaihati Fahd Abdulaziz Almuhanna |
| author_sort | Marwan J. Alwazzeh |
| collection | DOAJ |
| description | Abstract Background Multidrug-resistant Acinetobacter baumannii emerged as a threatening “superbug” with significant morbidity and mortality and limited antimicrobial therapy options. The results of different antibiotic combination studies are heterogeneous and controversial. Further comparative studies are crucial to overcome such difficult-to-treat infections and to improve patient outcomes. This study investigates the mortality and outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients. Methods A retrospective observational study was conducted at an academic tertiary hospital in Khobar City, Eastern Province, Saudi Arabia. Patients who fulfilled the inclusion criteria and were admitted from January 1, 2017, to December 31, 2022, were included. The investigated primary outcome was 30-day mortality, while secondary outcomes were one-year all-cause mortality, clinical cure, microbiologic eradication, and recurrence of Acinetobacter infections. Statistical comparisons were employed, and a P-value of ≤ .05 was considered significant. Results Of the 178 patients who fulfilled the inclusion criteria, 47 received colistin only, and 131 received colistin in combinations (55 with carbapenems, 53 with tigecycline, and 23 with both). The estimated 30-day mortality rate of the study population was 22.5%, with statistically insignificant differences in 30-day mortality rates when the colistin group compared to cumulative colistin-based combination (23.4% vs. 22.1%; difference, 1.3 percentage points; 95% confidence interval [CI], 0.487–2.371; P = 0.858) or subgroups. However, colistin-based combination groups showed better secondary outcomes, with significantly less all-cause mortality and better clinical cure in colistin combination with carbapenems or tigecycline and less Acinetobacter infection recurrence in combination with carbapenems. Conclusions The study findings demonstrate the benefits of investigated colistin combination options that result in less one-year all-cause mortality, better clinical cure, higher microbiologic response, and less infection recurrence. However, no significant differences were observed regarding 30-day mortality. In addition, the study highlights the limitations of the available antimicrobial options and the crucial need for new effective antimicrobials and more successful combinations. |
| format | Article |
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| institution | OA Journals |
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| language | English |
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| spelling | doaj-art-db01cc90761f42b4b89919206dafde212025-08-20T02:10:17ZengBMCBMC Infectious Diseases1471-23342025-03-0125111310.1186/s12879-025-10781-1Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patientsMarwan J. Alwazzeh0Jumanah Algazaq1Fatimah Ali Al-Salem2Fatimah Alabkari3Sara M. Alwarthan4Mashael Alhajri5Bashayer M. AlShehail6Amani Alnimr7Ahmad Wajeeh Alrefaai8Faten Hussain Alsaihati9Fahd Abdulaziz Almuhanna10Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the UniversityInfectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the UniversityInfectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the UniversityInfectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the UniversityInfectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the UniversityInfectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, & King Fahad Hospital of the UniversityPharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal UniversityDepartment of Microbiology, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal UniversityDepartment of Microbiology, College of Medicine, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal UniversityDepartment of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Fahad Hospital of the UniversityNephrology Division, Department of Internal Medicine, Faculty of Medicine, Imam Abdulrahman Bin Faisal University, Fahad Hospital of the UniversityAbstract Background Multidrug-resistant Acinetobacter baumannii emerged as a threatening “superbug” with significant morbidity and mortality and limited antimicrobial therapy options. The results of different antibiotic combination studies are heterogeneous and controversial. Further comparative studies are crucial to overcome such difficult-to-treat infections and to improve patient outcomes. This study investigates the mortality and outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients. Methods A retrospective observational study was conducted at an academic tertiary hospital in Khobar City, Eastern Province, Saudi Arabia. Patients who fulfilled the inclusion criteria and were admitted from January 1, 2017, to December 31, 2022, were included. The investigated primary outcome was 30-day mortality, while secondary outcomes were one-year all-cause mortality, clinical cure, microbiologic eradication, and recurrence of Acinetobacter infections. Statistical comparisons were employed, and a P-value of ≤ .05 was considered significant. Results Of the 178 patients who fulfilled the inclusion criteria, 47 received colistin only, and 131 received colistin in combinations (55 with carbapenems, 53 with tigecycline, and 23 with both). The estimated 30-day mortality rate of the study population was 22.5%, with statistically insignificant differences in 30-day mortality rates when the colistin group compared to cumulative colistin-based combination (23.4% vs. 22.1%; difference, 1.3 percentage points; 95% confidence interval [CI], 0.487–2.371; P = 0.858) or subgroups. However, colistin-based combination groups showed better secondary outcomes, with significantly less all-cause mortality and better clinical cure in colistin combination with carbapenems or tigecycline and less Acinetobacter infection recurrence in combination with carbapenems. Conclusions The study findings demonstrate the benefits of investigated colistin combination options that result in less one-year all-cause mortality, better clinical cure, higher microbiologic response, and less infection recurrence. However, no significant differences were observed regarding 30-day mortality. In addition, the study highlights the limitations of the available antimicrobial options and the crucial need for new effective antimicrobials and more successful combinations.https://doi.org/10.1186/s12879-025-10781-1Acinetobacter baumanniiColistinCarbapenemTigecyclineCombinationOutcome |
| spellingShingle | Marwan J. Alwazzeh Jumanah Algazaq Fatimah Ali Al-Salem Fatimah Alabkari Sara M. Alwarthan Mashael Alhajri Bashayer M. AlShehail Amani Alnimr Ahmad Wajeeh Alrefaai Faten Hussain Alsaihati Fahd Abdulaziz Almuhanna Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients BMC Infectious Diseases Acinetobacter baumannii Colistin Carbapenem Tigecycline Combination Outcome |
| title | Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients |
| title_full | Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients |
| title_fullStr | Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients |
| title_full_unstemmed | Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients |
| title_short | Mortality and clinical outcomes of colistin versus colistin-based combination therapy for infections caused by Multidrug-resistant Acinetobacter baumannii in critically ill patients |
| title_sort | mortality and clinical outcomes of colistin versus colistin based combination therapy for infections caused by multidrug resistant acinetobacter baumannii in critically ill patients |
| topic | Acinetobacter baumannii Colistin Carbapenem Tigecycline Combination Outcome |
| url | https://doi.org/10.1186/s12879-025-10781-1 |
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