Details

Autor(en) / Beteiligte

• Batirel, A.
• Balkan, I. I.
• Karabay, O.
• Agalar, C.
• Akalin, S.
• Alici, O.
• Alp, E.
• Altay, F. A.
• Altin, N.
• Arslan, F.
• Aslan, T.
• Bekiroglu, N.
• Cesur, S.
• Celik, A. D.
• Dogan, M.
• Durdu, B.
• Duygu, F.
• Engin, A.
• Engin, D. O.
• Gonen, I.
• Guclu, E.
• Guven, T.
• Hatipoglu, C. A.
• Hosoglu, S.
• Karahocagil, M. K.
• Kilic, A. U.
• Ormen, B.
• Ozdemir, D.
• Ozer, S.
• Oztoprak, N.
• Sezak, N.
• Turhan, V.
• Turker, N.
• Yilmaz, H.

Titel

Comparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections

Ist Teil von

• European journal of clinical microbiology & infectious diseases, 2014-08, Vol.33 (8), p.1311-1322

Ort / Verlag

Berlin/Heidelberg: Springer Berlin Heidelberg

Erscheinungsjahr

2014

Quelle

SpringerLink

Beschreibungen/Notizen

• 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.