Colistin/sulbactam for CRAB pneumonia
Trial question
What is the effect of addition of colistin to high-dose sulbactam in patients with carbapenem-resistant A. baumannii pneumonia?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
29.0% female
71.0% male
N = 138
138 patients (40 female, 98 male).
Inclusion criteria: adult patients diagnosed with carbapenem-resistant A. baumannii pneumonia.
Key exclusion criteria: > 1 pathogenic organism isolated from sputum or infection with colistin-resistant, carbapenem-resistant A. baumannii pneumonia; previous colistin treatment lasting over 5 days; preexisting infections undergoing treatment at the time of study enrolment; co-infections affecting organs other than the lungs; pregnancy; allergy to colistin or sulbactam.
Interventions
N=69 high-dose sulbactam plus colistin (sulbactam 12 g/day plus colistin for 7 days).
N=69 low-dose sulbactam plus colistin (sulbactam 9 g/day plus colistin for 7 days).
Primary outcome
Death at day 28
47.8%
59.4%
59.4 %
44.5 %
29.7 %
14.8 %
0.0 %
High-dose sulbactam plus
colistin
Low-dose sulbactam plus
colistin
Significant
decrease ▼
NNT = 8
Significant decrease in death at day 28 (47.8% vs. 59.4%; HR 0.54, 95% CI 0.33 to 0.87).
Secondary outcomes
Significant increase in microbiological cure rate at day 7 (89.4% vs. 73.2%; AD 16.2%, 95% CI 2.53 to 29.87).
No significant difference in the rate of successful cessation of mechanical ventilation within 28 days (40.9% vs. 25%; HR 1.46, 95% CI 0.79 to 2.71).
No significant difference in the rate of discharge from hospital within 28 days (13% vs. 10.1%; HR 1.11, 95% CI 0.41 to 2.99).
Safety outcomes
No significant difference in AKI and diarrhea.
Significant difference in adverse events (31.9% vs. 50.7%).
Conclusion
In adult patients diagnosed with carbapenem-resistant A. baumannii pneumonia, high-dose sulbactam plus colistin was superior to low-dose sulbactam plus colistin with respect to death at day 28.
Reference
Chutchawan Ungthammakhun, Vasin Vasikasin, Waristha Simsiriporn et al. Effect of colistin combined with sulbactam: 9 g versus 12 g per day on mortality in the treatment of carbapenems resistant Acinetobacter baumannii pneumonia: a randomized controlled trial. Int J Infect Dis. 2024 Dec:149:107267.
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