Breakthrough Acinetobacter bacteremia during carbapenem therapy is not uncommon and creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough Acinetobacter bacteremia during carbapenem therapy and to assess the efficacy of various antimicrobial therapies. We analyzed 100 adults who developed breakthrough Acinetobacter bacteremia during carbapenem therapy at 4 medical centers over a 6-year period. Their 30-day mortality rate was 57.0% and the carbapenem resistance rate of their isolates was 87.0%. Among patients with carbapenem-resistant Acinetobacter bacteremia, breakthrough bacteremia during carbapenem therapy was associated with a significant higher 14-day mortality (51.7% versus 37.4%, P = 0.025 by bivariate analysis) and a higher 30-day mortality (P = 0.037 by log-rank test of survival analysis) than in the non-breakthrough group. For treatment of breakthrough Acinetobacter bacteremia during carbapenem therapy, tigecycline-based therapy was associated with a significantly higher 30-day mortality (80.0%) than continued carbapenem therapy (52.5%) and colistin-based therapy (57.9%) by survival analysis (P = 0.047 and 0.045 by log-rank test, respectively). Cox regression controlling for confounders, including severity of illness indices, demonstrated that patients treated with tigecycline-based therapy for breakthrough Acinetobacter bacteremia was an independent predictor of 30-day mortality (hazard ratio, 3.659; 95% confidence interval, 1.794-7.465; P < 0.001). Patients with breakthrough Acinetobacter bacteremia during carbapenem therapy posed a poor outcome. Tigecycline should be used cautiously for treatment of breakthrough Acinetobacter bacteremia that develops during carbapenem therapy.
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