Introduction:

Acinetobacter baumannii is associated with high morbidity and mortality, longer hospital stays, and, therefore, a great health impact.

Objectives:

To compare the clinical response and survival using intravenous colistin as antibiotic treatment versus colistin combined with high doses of ampicillin/sulbactam in multidrug-resistant A. baumannii infections in the adult intensive care units of the National Hospital (Itauguá, Paraguay).

Materials and methods:

A retrospective cohort design was applied to analyze the clinical and laboratory response, 14-day survival, and mortality rate in patients treated with colistin five mg/kg/day as monotherapy versus combined colistin therapy five mg/kg/day plus ampicillin/sulbactam 9 grams four times a day. The variables were obtained from the clinical records of patients ≥18 years old infected with multidrug-resistant A. baumannii.

Results:

One hundred sixty-three patients were included, with a mean age of 50 ± 17 years, 61.96% male. Pneumonia associated with mechanical ventilation was present in 69.33%, bacteremia in 21.47%, ventriculitis in 5.52% and infections related to the central venous line in 3.68%. A cohort of 88 patients received monotherapy with intravenous colistin and another of 75 patients received combined therapy with intravenous colistin plus high doses of ampicillin/sulbactam. No differences were found in the APACHE II score between both cohorts. The cohort with combined treatment demonstrated statistically significant superiority by presenting clinical and laboratory improvement at 72 hours, less need for vasopressors, better survival at 14 days, and less nephrotoxicity. The overall mortality rate was 45.40%.

Conclusion:

The combined therapy of intravenous colistin with high doses of ampicillin/sulbactam in prolonged infusion was related to early clinical improvement, shorter time requiring vasopressors and mechanical ventilation, greater survival at 14 days, and less nephrotoxicity.

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