The Effectiveness of Colistin/Rifampin Compared to Colistin/Meropenem in the Treatment of Ventilator-associated Pneumonia Caused by Carbapenem-resistant Acinetobacter baumannii: A Randomized Controlled Clinical Trial

Abstract

Objective:Treating ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) is still a significant challenge. This study evaluated the effectiveness of the colistin/rifampin regimen compared to the usual colistin/meropenem regimen in treating patients with VAP caused by CRAB.Methods:In a randomized controlled clinical trial, the patients with CRAB-related VAP were randomly assigned to experimental (n = 21) and control (n = 24) groups. The first group received colistin 4.5 MIU IV infusion every 12 h and rifampin 300 mg PO every 12 h, and the second group received colistin with the same dose and meropenem 2 g IV every 8 h for 10 days. The clinical response (complete response, partial response, or treatment failure) and mortality rate at the end of the intervention were recorded and compared between the two groups.Findings:The complete response rate was higher (n = 8; 66.70), and the failure rate was lower (n = 4; 26.70) in the experimental group than in the control group (n = 4; 33.30, and n = 11; 73.30, respectively), but the differences were not statistically significant. The mortality rate was three patients in both experimental (14.28) and control (12.50) groups; however, the difference was not statistically significant (P = 0.860; odds ratio: 1.143, 95 confidence interval: 0.258-5.067).Conclusion:The colistin/rifampin combination can be considered an alternative regimen to colistin/meropenem in the treatment of VAP caused by CRAB.