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Comparison of colistin carbapenem colistin sulbactam and colistin plus other antibacterial agents for the treatment of extremely drug resistant Acinetobacter baumannii bloodstream infections        
Yazarlar
Ayşe Batırel
İlker İnanç Ibalkan
Oğuz Karabay
Sakarya Üniversitesi, Türkiye
Canan Ağalar
Şerife Akalın
Pamukkale Üniversitesi, Türkiye
Özlem Alıcı
Emine Alp Meşe
Erciyes Üniversitesi, Türkiye
Fatma Aybala Altay
N Altın
Ferhat Arslan
İstanbul Medipol Üniversitesi, Türkiye
Turan Aslan
Bezm-İ Âlem Vakıf Üniversitesi, Türkiye
Gülnaz Nural Bekiroğlu
Marmara Üniversitesi, Türkiye
Salih Cesur
Aygül Çelik
Trakya Üniversitesi, Türkiye
Mustafa Doğan
Namık Kemal Üniversitesi, Türkiye
Bülent Durdu
Bezm-İ Âlem Vakıf Üniversitesi, Türkiye
Fazilet Duygu
Gaziosmanpaşa Üniversitesi, Türkiye
Aynur Engin
Cumhuriyet Üniversitesi, Türkiye
Do Engin
İbak Gönen
Süleyman Demirel Üniversitesi, Türkiye
Ertuğrul Güçlü
Sakarya Üniversitesi, Türkiye
Tümer Güven
Yıldırım Beyazıt Üniversitesi, Türkiye
Çiğdem Ataman Hatipoğlu
Salih Hoşoğlu
Fatih Üniversitesi, Türkiye
Prof. Dr. Mustafa Kasım KARAHOCAGİL Prof. Dr. Mustafa Kasım KARAHOCAGİL
Yüzüncü Yıl Üniversitesi, Türkiye
Ayşegül Ulu Kılıç
Erciyes Üniversitesi, Türkiye
Bahar Örmen
Davut Özdemir
Düzce Üniversitesi, Türkiye
S Özer
Nefise Öztoprak
N Sezak
Vedat Turhan
Gülhane Askeri Tıp Akademisi, Türkiye
N Türker
H Yılmaz
Özet
The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7 %): colistin-carbapenem (CC), 69 (32.2 %): colistin-sulbactam (CS), and 43 (20.1 %: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.
Anahtar Kelimeler
Makale Türü Özgün Makale
Makale Alt Türü SSCI, AHCI, SCI, SCI-Exp dergilerinde yayımlanan tam makale
Dergi Adı EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES
Dergi ISSN 0934-9723
Dergi Tarandığı Indeksler SSCI
Makale Dili İngilizce
Basım Tarihi 08-2014
Cilt No 33
Sayı 8
Sayfalar 1311 / 1322
Doi Numarası 10.1007/s10096-014-2070-6
Makale Linki http://link.springer.com/10.1007/s10096-014-2070-6