Frontiers in cellular and infection microbiology · 2026
Impact of multisite colonization and comparative microbiological outcomes of colistin-sulbactam vs. colistin-tigecycline in CRAB hospital-acquired pneumonia: a propensity score-matched analysis.
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Liao Shiyu, Shen Lan
Аннотация
BACKGROUND: The optimal combination therapy for carbapenem-resistant Acinetobacter baumannii (CRAB) pneumonia remains controversial. This study aimed to compare the microbiological efficacy, clinical outcomes, and safety of colistin-sulbactam versus colistin-tigecycline regimens in patients with CRAB hospital-acquired or ventilator-associated pneumonia (HAP/VAP).
METHODS: A single-center, retrospective cohort study was conducted from 2019 to 2024. Adult patients with culture-confirmed CRAB HAP/VAP receiving either colistin-sulbactam (Group A) or colistin-tigecycline (Group B) for ≥72 hours were included. Propensity score matching (PSM) was utilized to balance baseline covariates, including APACHE II scores and renal function. The primary endpoint was microbiological eradication at Day 7; secondary endpoints included 28-day all-cause mortality, clinical cure, and adverse events.
RESULTS: Among 176 eligible patients, 42 matched pairs (n=84) were generated. The colistin-sulbactam group achieved significantly higher microbiological eradication rates at Day 7 compared to the colistin-tigecycline group (66.7% vs. 40.5%; P = 0.013). Subgroup analysis revealed that this benefit was particularly pronounced in patients with extensively drug-resistant (XDR) strains (OR 4.75; 95% CI 1.58-14.26) and those with multisite colonization. Clinical cure rates were also higher in Group A (59.5% vs. 35.7%; P = 0.029). No significant difference was observed in 28-day all-cause mortality (31.0% vs. 38.1%; P = 0.490).
CONCLUSION: Colistin combined with high-dose sulbactam demonstrated higher microbiological clearance and clinical cure rates compared to colistin-tigecycline, particularly in patients with XDR strains and high bacterial burden. The sulbactam-based regimen offers a favorable efficacy and safety profile and should be considered a preferred therapeutic strategy for severe CRAB infections.
METHODS: A single-center, retrospective cohort study was conducted from 2019 to 2024. Adult patients with culture-confirmed CRAB HAP/VAP receiving either colistin-sulbactam (Group A) or colistin-tigecycline (Group B) for ≥72 hours were included. Propensity score matching (PSM) was utilized to balance baseline covariates, including APACHE II scores and renal function. The primary endpoint was microbiological eradication at Day 7; secondary endpoints included 28-day all-cause mortality, clinical cure, and adverse events.
RESULTS: Among 176 eligible patients, 42 matched pairs (n=84) were generated. The colistin-sulbactam group achieved significantly higher microbiological eradication rates at Day 7 compared to the colistin-tigecycline group (66.7% vs. 40.5%; P = 0.013). Subgroup analysis revealed that this benefit was particularly pronounced in patients with extensively drug-resistant (XDR) strains (OR 4.75; 95% CI 1.58-14.26) and those with multisite colonization. Clinical cure rates were also higher in Group A (59.5% vs. 35.7%; P = 0.029). No significant difference was observed in 28-day all-cause mortality (31.0% vs. 38.1%; P = 0.490).
CONCLUSION: Colistin combined with high-dose sulbactam demonstrated higher microbiological clearance and clinical cure rates compared to colistin-tigecycline, particularly in patients with XDR strains and high bacterial burden. The sulbactam-based regimen offers a favorable efficacy and safety profile and should be considered a preferred therapeutic strategy for severe CRAB infections.
Предметные рубрики MeSH
HumansSulbactamFemaleColistinAcinetobacter baumanniiRetrospective StudiesMaleAnti-Bacterial AgentsPropensity ScoreAcinetobacter InfectionsAgedTreatment OutcomeMiddle AgedHealthcare-Associated PneumoniaPneumonia, Ventilator-AssociatedDrug Therapy, CombinationCarbapenemsDrug Resistance, Multiple, BacterialAged, 80 and over