Karbapeneme Dirençli Acinetobacter Spp. İnfeksiyonları
Özet
Karbapeneme dirençli Acinetobacter baumannii-calcoaceticus kompleksi (CRAB), özellikle YBÜ’lerde sağlık bakımıyla ilişkili infeksiyonların önde gelen etkenlerinden biri haline gelmiştir. CRAB infeksiyonları YBÜ’de kalış süresi, artan hasta maliyeti, antibiyotik kullanımı ve mortaliteyle anlamlı bir ilişki gösterir. Karbapenemaz genleri sıklıkla ek direnç genleri taşıyabilen plazmidler üzerinde kodlanır ve CRAB‘ı çok ilaca dirençli hale getirir. CRAB infeksiyonlarında tedavi yanıtı alınana kadar mümkünse iki aktif ajanla kombinasyon tedavisi verilmelidir. Bunlar yüksek doz ampisilin-sulbaktam, sulbaktam-durlobaktam, polimiksin B, yüksek doz tigesiklin veya minosiklin ve sefiderokol olabilir. CRAB infeksiyonlarında fosfomisin ve rifampisinli kombinasyonlar, inhaler tedaviler, yüksek doz ve uzun infüzyon karbapanem tedavisi günümüzde önerilmemektedir. Ülkemizde hafif-orta şiddettli CRAB infeksiyonlarında sulbaktam içeren tedaviler monoterapi şeklinde kullanılmaktadır. Ağır, şiddetli CRAB infeksiyonlarında ise antibiyogram sonuçlarına göre duyarlı iki antimikrobiyal ialç kombine ederek kullanılmaktadır. Sonuç olarak duyarlılık testi sonuçları, infeksiyon bölgesi ve CRAB infeksiyonları için yerel epidemiyolojik bilgilere dayalı olarak bireyselleştirilmiş tedavi rejimlerinin oluşturulması daha akılcı olacaktır.
Carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex (CRAB) has become one of the leading causes of healthcare-associated infections, especially in ICUs. CRAB infections are significantly associated with length of hospitalization in the ICU, increased patient costs, antibiotic use, and mortality. Carbapenemase genes are often encoded on plasmids that can carry additional resistance genes, making CRAB multidrug resistant. In CRAB infections, combination therapy with two active agents should be given, if possible, until a treatment response is achieved. These may be high dose ampicillin-sulbactam, sulbactam-durlobactam, polymyxin B, high-dose tigecycline or minocycline, and cefiderocol. Combinations with fosfomycin and rifampicin, inhaler treatments, and high dose long-infusion carbapanem treatment are not currently recommended in CRAB infections. In our country, treatments that containing sulbactam are used as monotherapy in mild to moderate CRAB infections. In severe CRAB infections, two sensitive combined antimicrobial drugs according to the antibiogram results are used. As a result, it would be more rational to create individualized treatment regimens based on susceptibility test results, infection site and local epidemiological information for CRAB infections.
Referanslar
Jiang Y, Ding Y, Wei Y, et al. Carbapenem-resistant Acinetobacter baumannii: A challenge in the intensive care unit. Front Microbiol. 2022:13:1045206. doi: 10.3389/fmicb.2022.1045206.
World Health Organization. Report on the burden of endemic health care-associated infection worldwide (30.05.2024 tarihinde https://iris.who.int/bitstream/handle/10665/80135/9789241501507_eng.pdf adresinden ulaşılmıştır).
World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed (30.05.2024 tarihinde https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed adresinden ulaşılmıştır).
Kadri SS, Adjemian J, Lai YL, et al. Difficult-to-Treat Resistance in Gram-negative Bacteremia at 173 US Hospitals: Retrospective Cohort Analysis of Prevalence, Predictors, and Outcome of Resistance to All First-line Agents. Clin Infect Dis. 2018;67(12):1803-1814. doi: 10.1093/cid/ciy378.
Hochman S, Phillips M. Acinetobacter species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philedelphia, 2020:2718-2724.
CDC. Carbapenem-Resistant Acinetobacter baumannii (30.05.2024 tarihinde https://arpsp.cdc.gov/profile/arln/crab adresinden ulaşılmıştır).
Yakupogullari Y, Otlu B, Ersoy Y, et al. Is airborne transmission of Acinetobacter baumannii possible: A prospective molecular epidemiologic study in a tertiary care hospital. Am J Infect Control. 2016;44(12):1595-1599. doi: 10.1016/j.ajic.2016.05.022.
CDC. Antibiotic Resistance Threats in the United States, 2019 (30.05.2024 tarihinde https://www.cdc.gov/antimicrobial-resistance/media/pdfs/2019-ar-threats-report-508.pdf?CDC_AAref_Val=https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf adresinden ulaşılmıştır)
Kaye KS, Marchaim D, Thamlikitkul V, et al. Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms. NEJM Evid. 2023;2(1):10.1056/evidoa2200131. doi: 10.1056/evidoa2200131.
Kaye KS, Shorr AF, Wunderink RG, et al. Efficacy and safety of sulbactam-durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii-calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK). Lancet Infect Dis. 2023;23(9):1072-1084. doi: 10.1016/S1473-3099(23)00184-6.
Seifert H, Blondeau J, Lucaßen K, et al. Global update on the in vitro activity of tigecycline and comparators against isolates of Acinetobacter baumannii and rates of resistant phenotypes (2016-2018). J Glob Antimicrob Resist. 2022:31:82-89. doi: 10.1016/j.jgar.2022.08.002.
Aydın M, Ergönül Ö, Azap A, et al. Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections. J Hosp Infect. 2018;98(3):260-263. doi: 10.1016/j.jhin.2017.11.014.
T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Ulusal Sağlık Hizmeti İlişkili Enfeksiyonlar Sürveyans Ağı (USHİESA) Etken Dağılımı ve Antibiyotik Direnç Raporu 2022 (30.05.2024 tarihinde https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Raporlar/ETKEN_DAGILIM_VE_DIRENC_2022_RAPOR-v2.pdf adresinden ulaşılmıştır).
Gottesman T, Fedorowsky R, Yerushalmi R, et al. An outbreak of carbapenem-resistant Acinetobacter baumannii in a COVID-19 dedicated hospital. Infect Prev Pract. 2021;3(1):100113. doi: 10.1016/j.infpip.2021.100113.
Kinross P, Gagliotti C, Merk H, et al. Large increase in bloodstream infections with carbapenem-resistant Acinetobacter species during the first 2 years of the COVID-19 pandemic, EU/EEA, 2020 and 2021. Euro Surveill. 2022;27(46):2200845. doi:10.2807/1560-7917.ES.2022.27.46.2200845.
Boral J, Genç Z, Pınarlık F, et al. The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit. Sci Rep. 2022;12(1):20808. doi: 10.1038/s41598-022-25493-8.
Pintado V, Ruiz-Garbajosa P, Aguilera-Alonso D, et al. Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the diagnosis and antimicrobial treatment of infections due to carbapenem-resistant Gram-negative bacteria. Enferm Infecc Microbiol Clin (Engl Ed). 2023;41(6):360-370. doi: 10.1016/j.eimce.2022.06.014.
Zeng M, Xia J, Zong Z, et al. uidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli. J Microbiol Immunol Infect. 2023;56(4):653-671. doi: 10.1016/j.jmii.2023.01.017.
Tiseo G, Brigante G, Giacobbe DR, et al. Diagnosis and management of infections caused by multidrug-resistant bacteria: guideline endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI) and the Italian Society of Microbiology (SIM). Int J Antimicrob Agents. 2022;60(2):106611. doi: 10.1016/j.ijantimicag.2022.106611.
Salman JA, Dabal LA, BassettiM, et al. Management of infections caused by WHO critical priority Gram-negative pathogens in Arab countries of the Middle East: a consensus paper. Int J Antimicrob Agents. 2020;56(4):106104. doi: 10.1016/j.ijantimicag.2020.106104.
Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America Guidance on the Treatment of AmpC β-Lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections. Clin Infect Dis. 2022;74(12):2089-2114. doi: 10.1093/cid/ciab1013.
Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. Clin Infect Dis. 2023:ciad428. doi: 10.1093/cid/ciad428.
Paul M, Carrara E, Retamar P, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine). Clin Microbiol Infect. 2022;28(4):521-547. doi: 10.1016/j.cmi.2021.11.025.
Jung SY, Lee SH, Lee SY, et al. Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis. Crit Care. 2017;21(1):319. doi: 10.1186/s13054-017-1916-6.
Liu J, Shu Y,Zhu F, et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: A systematic review and network meta-analysis. J Glob Antimicrob Resist. 2021:24:136-147. doi: 10.1016/j.jgar.2020.08.021.
Rattanaumpawan P, Lorsutthitham J, Ungprasert P, et al. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother. 2010;65(12):2645-9. doi: 10.1093/jac/dkq360.
Kollef MH, Ricard JD, Roux D, et al. A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia: IASIS Trial. Chest. 2017;151(6):1239-1246. doi: 10.1016/j.chest.2016.11.026.
Niederman MS, Alder J, Bassetti M, et al. Inhaled amikacin adjunctive to intravenous standard-of-care antibiotics in mechanically ventilated patients with Gram-negative pneumonia (INHALE): a double-blind, randomised, placebo-controlled, phase 3, superiority trial. Lancet Infect Dis. 2020;20(3):330-340. doi: 10.1016/S1473-3099(19)30574-2.
Qin JP, Huang HB, Zhou H, et al. Amikacin nebulization for the adjunctive therapy of gram-negative pneumonia in mechanically ventilated patients: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2021;11(1):6969. doi: 10.1038/s41598-021-86342-8.
Bassetti M, Echols R, Matsunaga Y, et al. Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): a randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial. Lancet Infect Dis. 2021;21(2):226-240. doi: 10.1016/S1473-3099(20)30796-9.
Portsmouth S, van Veenhuyzen D, Echols R, et al. Cefiderocol versus imipenem–cilastatin for the treatment of complicated urinary tract infections caused by Gram-negative uropathogens: a phase 2, randomised, double-blind, non-inferiority trial. Lancet Infect Dis. 2018;18:1319–28. doi: 10.1016/S1473-3099(18)30554-1.
Wunderink RG, Matsunaga Y, Ariyasu M, et al. Cefiderocol versus high-dose, extended-infusion meropenem for the treatment of Gram-negative nosocomial pneumonia (APEKS-NP): a randomised, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis. 2021;21:213–25, doi:http://dx.doi.org/10.1016/S1473-3099(20)30731-3.
Hsueh SC, Chao CM, Wang CY, et al. Clinical efficacy and safety of cefiderocol in the treatment of acute bacterial infections: A systematic review and meta-analysis of randomised controlled trials. J Glob Antimicrob Resist. 2021:24:376-382. doi: 10.1016/j.jgar.2021.02.004.
Sirijatuphat R, Thamlikitkul V. Preliminary study of colistin versus colistin plus fosfomycin for treatment of carbapenem-resistant Acinetobacter baumannii infections. Antimicrob Agents Chemother. 2014;58(9): 5598-601. doi: 10.1128/AAC.02435-13.
Referanslar
Jiang Y, Ding Y, Wei Y, et al. Carbapenem-resistant Acinetobacter baumannii: A challenge in the intensive care unit. Front Microbiol. 2022:13:1045206. doi: 10.3389/fmicb.2022.1045206.
World Health Organization. Report on the burden of endemic health care-associated infection worldwide (30.05.2024 tarihinde https://iris.who.int/bitstream/handle/10665/80135/9789241501507_eng.pdf adresinden ulaşılmıştır).
World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed (30.05.2024 tarihinde https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed adresinden ulaşılmıştır).
Kadri SS, Adjemian J, Lai YL, et al. Difficult-to-Treat Resistance in Gram-negative Bacteremia at 173 US Hospitals: Retrospective Cohort Analysis of Prevalence, Predictors, and Outcome of Resistance to All First-line Agents. Clin Infect Dis. 2018;67(12):1803-1814. doi: 10.1093/cid/ciy378.
Hochman S, Phillips M. Acinetobacter species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 9th ed. Philedelphia, 2020:2718-2724.
CDC. Carbapenem-Resistant Acinetobacter baumannii (30.05.2024 tarihinde https://arpsp.cdc.gov/profile/arln/crab adresinden ulaşılmıştır).
Yakupogullari Y, Otlu B, Ersoy Y, et al. Is airborne transmission of Acinetobacter baumannii possible: A prospective molecular epidemiologic study in a tertiary care hospital. Am J Infect Control. 2016;44(12):1595-1599. doi: 10.1016/j.ajic.2016.05.022.
CDC. Antibiotic Resistance Threats in the United States, 2019 (30.05.2024 tarihinde https://www.cdc.gov/antimicrobial-resistance/media/pdfs/2019-ar-threats-report-508.pdf?CDC_AAref_Val=https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf adresinden ulaşılmıştır)
Kaye KS, Marchaim D, Thamlikitkul V, et al. Colistin Monotherapy versus Combination Therapy for Carbapenem-Resistant Organisms. NEJM Evid. 2023;2(1):10.1056/evidoa2200131. doi: 10.1056/evidoa2200131.
Kaye KS, Shorr AF, Wunderink RG, et al. Efficacy and safety of sulbactam-durlobactam versus colistin for the treatment of patients with serious infections caused by Acinetobacter baumannii-calcoaceticus complex: a multicentre, randomised, active-controlled, phase 3, non-inferiority clinical trial (ATTACK). Lancet Infect Dis. 2023;23(9):1072-1084. doi: 10.1016/S1473-3099(23)00184-6.
Seifert H, Blondeau J, Lucaßen K, et al. Global update on the in vitro activity of tigecycline and comparators against isolates of Acinetobacter baumannii and rates of resistant phenotypes (2016-2018). J Glob Antimicrob Resist. 2022:31:82-89. doi: 10.1016/j.jgar.2022.08.002.
Aydın M, Ergönül Ö, Azap A, et al. Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections. J Hosp Infect. 2018;98(3):260-263. doi: 10.1016/j.jhin.2017.11.014.
T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Ulusal Sağlık Hizmeti İlişkili Enfeksiyonlar Sürveyans Ağı (USHİESA) Etken Dağılımı ve Antibiyotik Direnç Raporu 2022 (30.05.2024 tarihinde https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Raporlar/ETKEN_DAGILIM_VE_DIRENC_2022_RAPOR-v2.pdf adresinden ulaşılmıştır).
Gottesman T, Fedorowsky R, Yerushalmi R, et al. An outbreak of carbapenem-resistant Acinetobacter baumannii in a COVID-19 dedicated hospital. Infect Prev Pract. 2021;3(1):100113. doi: 10.1016/j.infpip.2021.100113.
Kinross P, Gagliotti C, Merk H, et al. Large increase in bloodstream infections with carbapenem-resistant Acinetobacter species during the first 2 years of the COVID-19 pandemic, EU/EEA, 2020 and 2021. Euro Surveill. 2022;27(46):2200845. doi:10.2807/1560-7917.ES.2022.27.46.2200845.
Boral J, Genç Z, Pınarlık F, et al. The association between Acinetobacter baumannii infections and the COVID-19 pandemic in an intensive care unit. Sci Rep. 2022;12(1):20808. doi: 10.1038/s41598-022-25493-8.
Pintado V, Ruiz-Garbajosa P, Aguilera-Alonso D, et al. Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the diagnosis and antimicrobial treatment of infections due to carbapenem-resistant Gram-negative bacteria. Enferm Infecc Microbiol Clin (Engl Ed). 2023;41(6):360-370. doi: 10.1016/j.eimce.2022.06.014.
Zeng M, Xia J, Zong Z, et al. uidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli. J Microbiol Immunol Infect. 2023;56(4):653-671. doi: 10.1016/j.jmii.2023.01.017.
Tiseo G, Brigante G, Giacobbe DR, et al. Diagnosis and management of infections caused by multidrug-resistant bacteria: guideline endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI) and the Italian Society of Microbiology (SIM). Int J Antimicrob Agents. 2022;60(2):106611. doi: 10.1016/j.ijantimicag.2022.106611.
Salman JA, Dabal LA, BassettiM, et al. Management of infections caused by WHO critical priority Gram-negative pathogens in Arab countries of the Middle East: a consensus paper. Int J Antimicrob Agents. 2020;56(4):106104. doi: 10.1016/j.ijantimicag.2020.106104.
Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America Guidance on the Treatment of AmpC β-Lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections. Clin Infect Dis. 2022;74(12):2089-2114. doi: 10.1093/cid/ciab1013.
Tamma PD, Aitken SL, Bonomo RA, et al. Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections. Clin Infect Dis. 2023:ciad428. doi: 10.1093/cid/ciad428.
Paul M, Carrara E, Retamar P, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine). Clin Microbiol Infect. 2022;28(4):521-547. doi: 10.1016/j.cmi.2021.11.025.
Jung SY, Lee SH, Lee SY, et al. Antimicrobials for the treatment of drug-resistant Acinetobacter baumannii pneumonia in critically ill patients: a systemic review and Bayesian network meta-analysis. Crit Care. 2017;21(1):319. doi: 10.1186/s13054-017-1916-6.
Liu J, Shu Y,Zhu F, et al. Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: A systematic review and network meta-analysis. J Glob Antimicrob Resist. 2021:24:136-147. doi: 10.1016/j.jgar.2020.08.021.
Rattanaumpawan P, Lorsutthitham J, Ungprasert P, et al. Randomized controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother. 2010;65(12):2645-9. doi: 10.1093/jac/dkq360.
Kollef MH, Ricard JD, Roux D, et al. A Randomized Trial of the Amikacin Fosfomycin Inhalation System for the Adjunctive Therapy of Gram-Negative Ventilator-Associated Pneumonia: IASIS Trial. Chest. 2017;151(6):1239-1246. doi: 10.1016/j.chest.2016.11.026.
Niederman MS, Alder J, Bassetti M, et al. Inhaled amikacin adjunctive to intravenous standard-of-care antibiotics in mechanically ventilated patients with Gram-negative pneumonia (INHALE): a double-blind, randomised, placebo-controlled, phase 3, superiority trial. Lancet Infect Dis. 2020;20(3):330-340. doi: 10.1016/S1473-3099(19)30574-2.
Qin JP, Huang HB, Zhou H, et al. Amikacin nebulization for the adjunctive therapy of gram-negative pneumonia in mechanically ventilated patients: a systematic review and meta-analysis of randomized controlled trials. Sci Rep. 2021;11(1):6969. doi: 10.1038/s41598-021-86342-8.
Bassetti M, Echols R, Matsunaga Y, et al. Efficacy and safety of cefiderocol or best available therapy for the treatment of serious infections caused by carbapenem-resistant Gram-negative bacteria (CREDIBLE-CR): a randomised, open-label, multicentre, pathogen-focused, descriptive, phase 3 trial. Lancet Infect Dis. 2021;21(2):226-240. doi: 10.1016/S1473-3099(20)30796-9.
Portsmouth S, van Veenhuyzen D, Echols R, et al. Cefiderocol versus imipenem–cilastatin for the treatment of complicated urinary tract infections caused by Gram-negative uropathogens: a phase 2, randomised, double-blind, non-inferiority trial. Lancet Infect Dis. 2018;18:1319–28. doi: 10.1016/S1473-3099(18)30554-1.
Wunderink RG, Matsunaga Y, Ariyasu M, et al. Cefiderocol versus high-dose, extended-infusion meropenem for the treatment of Gram-negative nosocomial pneumonia (APEKS-NP): a randomised, double-blind, phase 3, non-inferiority trial. Lancet Infect Dis. 2021;21:213–25, doi:http://dx.doi.org/10.1016/S1473-3099(20)30731-3.
Hsueh SC, Chao CM, Wang CY, et al. Clinical efficacy and safety of cefiderocol in the treatment of acute bacterial infections: A systematic review and meta-analysis of randomised controlled trials. J Glob Antimicrob Resist. 2021:24:376-382. doi: 10.1016/j.jgar.2021.02.004.
Sirijatuphat R, Thamlikitkul V. Preliminary study of colistin versus colistin plus fosfomycin for treatment of carbapenem-resistant Acinetobacter baumannii infections. Antimicrob Agents Chemother. 2014;58(9): 5598-601. doi: 10.1128/AAC.02435-13.
