• Emanuele Durante-Mangoni, Giuseppe Signoriello, Roberto Andini, Annunziata Mattei, Maria De Cristoforo, Patrizia Murino, Matteo Bassetti, Paolo Malacarne, Nicola Petrosillo, Nicola Galdieri, Paola Mocavero, Antonio Corcione, Claudio Viscoli, Raffaele Zarrilli, Ciro Gallo, and Riccardo Utili.
• Internal Medicine Section, Department of Cardiothoracic Sciences, University of Naples S.U.N. and AORN Ospedali dei Colli, Monaldi Hospital, Italy.
• Clin. Infect. Dis. 2013 Aug 1;57(3):349-58.

BackgroundExtensively drug-resistant (XDR) Acinetobacter baumannii may cause serious infections in critically ill patients. Colistin often remains the only therapeutic option. Addition of rifampicin to colistin may be synergistic in vitro. In this study, we assessed whether the combination of colistin and rifampicin reduced the mortality of XDR A. baumannii infections compared to colistin alone.MethodsThis multicenter, parallel, randomized, open-label clinical trial enrolled 210 patients with life-threatening infections due to XDR A. baumannii from intensive care units of 5 tertiary care hospitals. Patients were randomly allocated (1:1) to either colistin alone, 2 MU every 8 hours intravenously, or colistin (as above), plus rifampicin 600 mg every 12 hours intravenously. The primary end point was overall 30-day mortality. Secondary end points were infection-related death, microbiologic eradication, and hospitalization length.ResultsDeath within 30 days from randomization occurred in 90 (43%) subjects, without difference between treatment arms (P = .95). This was confirmed by multivariable analysis (odds ratio, 0.88 [95% confidence interval, .46-1.69], P = .71). A significant increase of microbiologic eradication rate was observed in the colistin plus rifampicin arm (P = .034). No difference was observed for infection-related death and length of hospitalization.ConclusionsIn serious XDR A. baumannii infections, 30-day mortality is not reduced by addition of rifampicin to colistin. These results indicate that, at present, rifampicin should not be routinely combined with colistin in clinical practice. The increased rate of A. baumannii eradication with combination treatment could still imply a clinical benefit.Clinical Trials RegistrationNCT01577862.

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