Comparison of Meropenem-based triple therapy vs Minocycline-based Triple therapy for Carbapenem Resistant Acinetobacter baumannii Ventilator Associated Pneumonia - A Prospective Observational Study

Background Ventilator-associated pneumonia (VAP) resulted from Carbapenem-Resistant Acinetobacter baumannii (CRAB) poses serious treatment challenges. Our objective was to assess two triple medication combinations for VAP caused by CRAB. Methods This prospective observational research was performed in the critical care unit of an academic medical center from January 2024 to March 2025. Two hundred adult patients with culture-proven CRAB-VAP were enrolled and treated with either minocycline-polymyxin-sulbactam or meropenem-polymyxin-sulbactam. Various outcomes assessed were clinical recovery, 7 and 28-day mortality, microbiological eradication, duration of ICU and hospital stay. Results The clinical recovery rates were comparable in both groups (54% minocycline vs. 47% meropenem, p=0.322). The microbiological eradication rate was similar (39 % ) at day 28 in both groups. Patients treated with the minocycline regimen had significantly shorter ICU stay (16 vs. 18 days, p=0.003) and hospital stays (24 vs. 28 days, p<0.001) than the meropenem group. There was no significant difference between 7-day mortality (21% vs. 32%, p=0.078) or 28-day mortality (46% vs. 53%, p=0.322). Conclusion Minocycline-based triple therapy was comparable to meropenem-based therapy in treating CRAB-VAP, with potential advantages in reducing duration of ICU and hospital stay. Minocycline may be a suitable alternative for CRAB-VAP in resource-limited settings.