Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacte
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ORIGINAL RESEARCH
Efficacy of a Fosfomycin-Containing Regimen for Treatment of Severe Pneumonia Caused by Multidrug-Resistant Acinetobacter baumannii: A Prospective, Observational Study Alessandro Russo
. Matteo Bassetti . Valeria Bellelli .
Luigi Bianchi . Federica Marincola Cattaneo . Stefania Mazzocchetti . Elena Paciacconi . Fabrizio Cottini . Arcangelo Schiattarella . Giuseppe Tufaro . Francesco Sabetta . Alessandro D’Avino Received: September 7, 2020 / Accepted: October 8, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Severe pneumonia caused by multidrug-resistant Acinetobacter baumannii (MDR-AB) remains a difficult-to-treat infection. A. Russo (&) Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy e-mail: [email protected] A. Russo V. Bellelli L. Bianchi F. Marincola Cattaneo F. Sabetta Internal Medicine Unit, Policlinico Casilino, Rome, Italy M. Bassetti Department of Health Sciences, University of Genoa, Genoa, Italy S. Mazzocchetti E. Paciacconi Department of Intensive Care Unit, Cristo Re Hospital, Rome, Italy F. Cottini Intensive Care Unit, San Carlo di Nancy HospitalGVM Care and Research, Rome, Italy A. Schiattarella Department of Clinical Microbiology and Pathology, Cristo Re Hospital, Rome, Italy G. Tufaro Intensive Care Unit, Policlinico Casilino, Rome, Italy A. D’Avino Department of Internal Medicine and Risk Management, Cristo Re Hospital, Rome, Italy
Considering the poor lung penetration of most antibiotics, the choice of the better antibiotic regimen is debated. Methods: We performed a prospective, observational, multicenter study conducted from January 2017 to June 2020. All consecutive hospitalized patients with severe pneumonia due to MDR-AB were included in the study. The primary endpoint of the study was to evaluate risk factors associated with survival or death at 30 days from pneumonia onset. A propensity score for receiving therapy with fosfomycin was added to the model. Results: During the study period, 180 cases of hospital-acquired pneumonia, including ventilator-associated pneumonia, caused by MDR-AB strains were observed. Cox regression analysis of factors associated with 30-day mortality, after propensity score, showed that septic shock, and secondary bacteremia were associated with death, while a fosfomycin-containing regimen was associated with 30-day survival. Antibiotic combinations with fosfomycin in definitive therapy for 44 patients were: fosfomycin ? colistin in 11 (25%) patients followed by fosfomycin ? carbapenem ? tigecycline in 8 (18.2%), fosfomycin ? colistin ? tigecycline in 7 (15.9%), fosfomycin ? rifampin in 7 (15.9%), fosfomycin ? tigecycline in 6 (13.6%), fosfomycin ? carbapenem in 3 (6.8%), and fosfomycin ? aminoglycoside in 2 (4.5%).
Infect Dis Ther
Conclusions: This real-life clinical experience concerning the therapeutic approach to severe pneumonia caused by MDR-AB provides useful suggestions to clinicians, showing the use of different antibiotic regimens with a predominant role for fosfomycin.
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