Outcomes of Adjunctive Therapy with Intravenous Cefoperazone-Sulbactam for Ventilator-Associated Pneumonia Due to Carbapenem-Resistant Acinetobacter baumannii

Siripen Kanchanasuwan,1 Narongdet Kositpantawong,1 Kamonnut Singkhamanan,2 Thanaporn Hortiwakul,1 Boonsri Charoenmak,1 Nwabor Ozioma F,1,3 Yohei Doi,4,5 Sarunyou Chusri1,2 1Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand; 2Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand; 3Excellence Research Laboratory on Natural Products, Division of Biological Science, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand; 4Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 5Department of Microbiology, Fujita Health University, Aichi, JapanCorrespondence: Sarunyou Chusri Tel +66-89-7340446Fax +66-74-281457Email sarunyouchusri@hotmail.comIntroduction: The efficacy of adjunctive therapy with cefoperazone-sulbactam (CEP-SUL) for ventilator-associated pneumonia (VAP) due to carbapenem-resistant A. baumannii (CRAB) is unclear.Methods: We retrospectively analyzed the therapeutic effect of adding CEP-SUL to standard regimens for VAP due to CRAB. Patients with VAP due to CRAB strains that were susceptible to CEP-SUL were enrolled into the study. The patients were divided into two groups: those who receive cefoperazone-sulbactam (CEP-SUL+), and those who did not receive cefoperazone-sulbactam (CEP-SUL). Mortality rates and resource utilization of these two groups were compared. Factors associated with mortality were explored.Results: Eighty patients were enrolled into the study, 52 CEP-SUL+ and 28 CEP-SUL–. The baseline characteristics of the two groups were comparable, except for median Acute Physiology and Chronic Health Evaluation (APACHE) II score which was significantly higher for CEP-SUL+. Thirty-day, and in-hospital mortality rates for CEP-SUL+ were significantly lower than CEP-SUL– with values of 35%, 39% and 61%, 68%, for CEP-SUL+ and CEP-SUL–, respectively. The survival rate for CEP-SUL+ was significantly higher compared with CEP-SUL– (P < 0.001). The number of hospital days, ventilator days since diagnosis of VAP and hospital costs were lower for CEP-SUL+.Conclusion: Overall results suggested that patients with VAP due to CRAB strains who received adjunctive therapy with CEP-SUL had lower mortality rates and resource utilization compared with CEP-SUL–.Keywords: outcome, cefoperazone-sulbactam, ventilator-associated pneumonia, carbapenem-resistant Acinetobacter baumannii