ArticleFrontiers in cellular and infection microbiology2026
Impact of multisite colonization and comparative microbiological outcomes of colistin-sulbactam vs. colistin-tigecycline in CRAB hospital-acquired pneumonia: a propensity score-matched analysis.
Article in Frontiers in cellular and infection microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The optimal combination therapy for carbapenem-resistant Methods: A single-center, retrospective cohort study was conducted from 2019 to 2024. Adult patients with culture-confirmed CRAB HAP/VAP receiving either colistin-sulbactam (Group A) or colistin-tigecycline (Group B) for ≥72 hours were included. Propensity score matching (PSM) was utilized to balance baseline covariates, including APACHE II scores and renal function. The primary endpoint was microbiological eradication at Day 7; secondary endpoints included 28-day all-cause mortality, clinical cure, and adverse events. Results: Among 176 eligible patients, 42 matched pairs (n=84) were generated. The colistin-sulbactam group achieved significantly higher microbiological eradication rates at Day 7 compared to the colistin-tigecycline group (66.7% vs. 40.5%; P = 0.013). Subgroup analysis revealed that this benefit was particularly pronounced in patients with extensively drug-resistant (XDR) strains (OR 4.75; 95% CI 1.58-14.26) and those with multisite colonization. Clinical cure rates were also higher in Group A (59.5% vs. 35.7%; P = 0.029). No significant difference was observed in 28-day all-cause mortality (31.0% vs. 38.1%; P = 0.490). Conclusion: Colistin combined with high-dose sulbactam demonstrated higher microbiological clearance and clinical cure rates compared to colistin-tigecycline, particularly in patients with XDR strains and high bacterial burden. The sulbactam-based regimen offers a favorable efficacy and safety profile and should be considered a preferred therapeutic strategy for severe CRAB infections.
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