The Clinical Outcomes and Safety of Tigecycline in Monotherapy or Combination with Cefoperazone/sulbactam for Carbapenem-Resistant Acinetobacter Baumannii-Associated Pneumonia: A Multicenter Retrospective Study

Abstract Objective We aimed to evaluate clinical outcomes and safety in tigecycline (TGC) monotherapy or in combination with cefoperazone/sulbactam (CPS) treatment for patients with hospital-acquired pneumonia (HAP) infected by carbapenem-resistant Acinetobacter baumannii(CRAB). Methods This was a retrospective analysis of multicenter data from patients with CRAB HAP in 62 Chinese hospitals. Risk factors of receiving TGC with CPS therapy and predictors of mortality were used multivariate logistic and Cox regression analyses, respectively. Propensity score matching (PSM) evaluated the efficacies and safety of antimicrobial regimens. Results 180 patients included in our study, 95 used TGC monotherapy, and 85 used TGC with CPS therapy. The multivariate logistic regression analysis revealed that the risk factors were significantly associated with TGC with CPS therapy included the older age [P = 0.011], intensive care unit (ICU) admission[P = 0.007]. The multivariate Cox regression demonstrated that there was a significantly higher risk of 90-day mortality [P = 0.031] among subjects in TGC-CPS group. The subgroup of patients who received Standard dose TGC (SDT) plus CPS had a significantly higher rate of SOFA score ≧ 7(P = 0.009), and the 30/90-day mortality rate of patients was also higher. The variation of ALT, TBIL, Cr, Hb, and PLT did not differ between different antimicrobial regimens after PSM. Conclusion The severity of patient conditions and TGC doses were significantly associated with mortality. HDT combined with CPS was the prior treatment option for patients with CRAB HAP who were elderly, had ICU admission. We observed that different antimicrobial regimens had similar safety in liver/kidney/coagulation.