Yonsei Med J.  2006 Feb;47(1):63-69. 10.3349/ymj.2006.47.1.63.

Comparison of Efficacy of Cefoperazone/Sulbactam and Imipenem/Cilastatin for Treatment of Acinetobacter Bacteremia

• Choi JY
• Kim CO
• Park YS
• Yoon HJ
• Shin SY
• Kim YK
• Kim MS
• Kim YA
• Song YG
• Yong D
• Lee K
• Kim JM

• KMID: 1715874
• DOI: http://doi.org/10.3349/ymj.2006.47.1.63

Abstract

Multiple antibiotic reisistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/ cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/ sulbactam group and imipenem/ cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.

Keyword

Acinetobacter; bacteremia; cefoperazone/sulbactam; imipenem/cilastatin

MeSH Terms

Sulbactam/*therapeutic use
Protease Inhibitors/therapeutic use
Middle Aged
Male
Imipenem/therapeutic use
Humans
Female
Drug Therapy, Combination
Drug Resistance, Bacterial
Cilastatin/therapeutic use
Cefoperazone/*therapeutic use
Bacteremia/*drug therapy
Anti-Bacterial Agents/*therapeutic use
Aged
Adult
Adolescent
Acinetobacter Infections/*drug therapy/mortality
Acinetobacter/drug effects/isolation & purification

Reference

1. Urban C, Segal-Maurer S, Rahal JJ. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin Infect Dis. 2003. 36:1268–1274.

2. Corbella X, Ariza J, Ardanuy C, Vuelta M, Tubau F, Sora M, et al. Efficacy of sulbactam alone and in combination with ampicillin in nosocomial infections caused by multiresistant Acinetobacter baumannii. J Antimicrob Chemother. 1998. 42:793–802.

3. Bergogne-Berezin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin Microbiol Rev. 1996. 9:148–165.

4. Cisneros JM, Reyes MJ, Pachon J, Becerri B, Caballero FJ, Garcia-Garmendia JL, et al. Bacteremia due to Acibetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis. 1996. 22:1026–1032.

5. Lee K, Kim YA, Park YJ, Lee HS, Kim MY, Kim EC, et al. Increasing prevalence of vancomycin-resistant Enterococci, and cefoxitin-, imipenem- and fluoroquinolone-resistant Gram-negative bacilli: a KONSAR study in 2002. Yonsei Med J. 2004. 45:598–608.

6. Levin AS. Multiresistant Acinetobacter infections: a role for sulbactam combinations in overcoming an emerging worldwide problem. Clin Microbiol Infect. 2002. 8:144–153.

7. Wood GC, Hanes SD, Croce MA, Fabian TC, Boucher BA. Comparison of ampicillin-sulbactam and imipenem-cilastatin for the treatment of Acinetobacter ventilator-associated pneumonia. Clin Infect Dis. 2002. 34:1425–1430.

8. Farmer JJ III. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Enterobacteriaceae: introduction and identification. Manual of clinical microbiology. 1999. 7th ed. Washington DC: American Society for Microbiology;442–458.

9. National Committee for Clinical Laboratory Standards. NCCLS document M100-S12. Performance standards for antimicrobial disk susceptibility testing-twelfth informational supplement. 2002. Wayne, Pa: National Committee for Clinical Laboratory Standards.

10. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control. 1988. 16:128–140.

11. Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med. 2003. 115:529–535.

12. Cisneros JM, Rodriquez-Banño J. Nosocomial bacteremia due to Acinetobacter baumannii: epidemiology, clinical features and treatment. Clin Microbiol Infect. 2002. 8:687–693.

13. Obana Y, Nishino T. In-vitro and in-vivo activities of sulbactam and YTR830H against Acinetobacter calcoaceticus. J Antimicrob Chemother. 1990. 26:677–682.

14. Vila J, Marcos A, Marco F, Abdalla S, Vergara Y, Reig R, et al. In vitro antimicrobial production of beta-lactamases, aminoglycoside-modifying enzymes, and chloramphenicol acetyltransferae by and susceptibility of clinical isolates of Acinetobacter baumannii. Antimicrob Agents Chemother. 1993. 37:138–141.

15. Rodriquez-Hernandez MJ, Cuberos L, Pichardo C, Caballero FJ, Moreno I, Jimenez-Mejias ME, et al. Sulbactam efficacy in experimental models caused by susceptible and intermediate Acinetobacter baumannii strains. J Antimicrob Chemother. 2001. 47:479–482.

16. Jellison TK, McKinnon PS, Rybak MJ. Epidemiology, resistance, and outcomes of Acinetobacter baumannii bacteremia treated with imipenem-cilastin or ampicillin-sulbactam. Pharmacotherapy. 2001. 21:142–148.

17. Urban C, Go E, Mariano N, Berger BJ, Avraham I, Rubin D, et al. Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis. 1993. 167:448–451.

18. Lim VK, Cheong YM. In vitro activity of cefoperazone-sulbactam combination against cefoperazone resistant clinical isolates in a Malaysian general hospital. Malays J Pathol. 1995. 17:73–76.

19. Jones RN, Wilson HW, Thornsberry C, Barry AL. In vitro antimicrobial activity of cefoperazone-sulbactam combinations against 554 clinical isolates including a review and beta-lactamase studies. Diagn Microbiol Infect Dis. 1985. 3:489–499.

20. Eliopoulos GM, Klimm K, Ferraro MJ, Moellering RCJ. In vitro activity of cefoperazone-sulbactam combinations against cefoperazone-resistant clinical bacterial isolates. Eur J Clin Microbiol Infect Dis. 1989. 8:624–626.

21. Knapp CC, Sierra-Madero J, Washington JA. Comparative in vitro activity of cefoperazone and various combinations of cefoperazone/sulbactam. Diagn Microbiol Infect Dis. 1989. 13:45–49.

22. Gales AC, Jones RN, Forward KR, Linares J, Sader HS, Verhoef J. Emerging importance of multidrug-resistant Acibetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trend in the SENTRY antimicrobial surveillance program (1997-1999). Clin Infect Dis. 2001. 32:Suppl 2. S104–S113.

23. Yamaguchi K, Mathai D, Biedenbach DJ, Lewis MT, Gales AC, Jones RN. Evaluation of the in vitro activity of six broad-spectrum beta-lactam antimicrobial agents tested against over 2,000 clinical isolates from 22 medical centers in Japan. Diagn Microbiol Infect Dis. 1999. 34:123–134.

24. Jones RN, Salazar JC, Pfaller MA, Doern GV. Multicenter evaluation of antimicrobial resistance to six broad-spectrum beta-lactams in Colombia using the Etest method. Diagn Microbiol Infect Dis. 1997. 29:265–272.

25. Wood CA, Reboli AC. Infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis. 1993. 167:448–451.

26. Levin AS, Barone AA, Penco J, Santos MV, Marinho IS, Arruda EA, et al. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis. 1999. 28:1008–1011.