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1. Variables determining mortality in patients with Acinetobacter baumannii meningitis/ventriculitis treated with intrathecal colistin.

Author

Ceylan B, Arslan F, Sipahi OR, Sunbul M, Ormen B, Hakyemez İN, Turunc T, Yıldız Y, Karsen H, Karagoz G, Tekin R, Hizarci B, Turhan V, Senol S, Oztoprak N, Yılmaz M, Ozdemir K, Mermer S, Kokoglu OF, and Mert A

Subjects
Acinetobacter Infections epidemiology, Adult, Aged, Anti-Bacterial Agents administration & dosage, Case-Control Studies, Cerebral Ventriculitis epidemiology, Colistin administration & dosage, Female, Humans, Injections, Spinal, Male, Meningitis, Bacterial epidemiology, Meropenem, Middle Aged, Retrospective Studies, Thienamycins administration & dosage, Young Adult, Acinetobacter Infections mortality, Acinetobacter baumannii pathogenicity, Anti-Bacterial Agents pharmacology, Cerebral Ventriculitis mortality, Colistin pharmacology, Meningitis, Bacterial mortality, Outcome Assessment, Health Care, Thienamycins pharmacology
Abstract

Aim: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin., Materials and Methods: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis., Results: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality., Conclusions: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation., (Copyright © 2016. Published by Elsevier B.V.)

Published
2017
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2. Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: a multicenter retrospective analysis.

Author

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

Subjects
APACHE, Acinetobacter pathogenicity, Acinetobacter Infections microbiology, Acinetobacter Infections mortality, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents adverse effects, Bacteremia microbiology, Bacteremia mortality, Chi-Square Distribution, Colistin adverse effects, Comorbidity, Drug Therapy, Combination, Female, Humans, Kaplan-Meier Estimate, Length of Stay, Male, Middle Aged, Multivariate Analysis, Proportional Hazards Models, Remission Induction, Retrospective Studies, Risk Factors, Tertiary Care Centers, Time Factors, Treatment Outcome, Turkey, Young Adult, Acinetobacter drug effects, Acinetobacter Infections drug therapy, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Colistin therapeutic use, Drug Resistance, Multiple, Bacterial
Abstract

Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A)., Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included., Primary End-Point: 14-day mortality., Secondary End-Points: Microbial eradication and clinical improvement., Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis., Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Published
2015
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3. Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections.

Author

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

Subjects
Acinetobacter baumannii isolation & purification, Adult, Aged, Carbapenems pharmacology, Colistin pharmacology, Drug Resistance, Multiple, Bacterial, Drug Therapy, Combination, Female, Humans, Length of Stay, Male, Microbial Sensitivity Tests, Middle Aged, Retrospective Studies, Risk Factors, Sulbactam pharmacology, Treatment Outcome, Acinetobacter Infections drug therapy, Acinetobacter baumannii drug effects, Bacteremia drug therapy, Carbapenems therapeutic use, Colistin therapeutic use, Sulbactam therapeutic use
Abstract

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.

Published
2014
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4. Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: A Multicenter retrospective analysis

Author

Tumer Guven, Nilgün Altın, Serife Akalin, Nefise Oztoprak, Derya Ozturk Engin, Salih Hosoglu, Davut Ozdemir, Fatma Aybala Altay, N. Turker, Aysegul Ulu Kilic, Ibak Gonen, Aygul Dogan Celik, Vedat Turhan, Oguz Karabay, Salih Cesur, Ozlem Alici, Bülent Durdu, Mustafa Dogan, Ilker Inanc Balkan, Nural Bekiroglu, Canan Agalar, Ferhat Arslan, Emine Alp, Mustafa Kasim Karahocagil, Fazilet Duygu, Serdar Özer, Ayse Batirel, Bahar Ormen, Ertugrul Guclu, Nurbanu Sezak, Turan Aslan, Aynur Engin, Cigdem Ataman Hatipoglu, Hava Yilmaz, DURDU, BÜLENT, [Balkan, Ilker Inanc] Istanbul Univ, Cerrahpasa Med Fac, Istanbul, Turkey -- [Batirel, Ayse -- Ozer, Serdar] Kartal Dr Lutfi Kirdar Educ & Res Hosp, Istanbul, Turkey -- [Agalar, Canan -- Alici, Ozlem] Fatih Sultan Mehmet Educ & Res Hosp, Istanbul, Turkey -- [Arslan, Ferhat] Istanbul Medipol Univ, Fac Med, Istanbul, Turkey -- [Aslan, Turan] Bezmi Alem Univ, Fac Med, Istanbul, Turkey -- [Engin, Derya Ozturk] Haydarpasa Numune Educ & Res Hosp, Istanbul, Turkey -- [Bekiroglu, Nural] Marmara Univ, Fac Med, Istanbul, Turkey -- [Durdu, Bulent] Bakirkoy Sadi Konuk Educ & Res Hosp, Istanbul, Turkey -- [Turhan, Vedat] GATA Haydarpasa Educ & Res Hosp, Istanbul, Turkey -- [Karabay, Oguz -- Guciu, Ertugrul] Sakarya Univ, Fac Med, Sakarya, Turkey -- [Akalin, Serife] Pamukkale Univ, Fac Med, Denizli, Turkey -- [Alp, Emine -- Kilic, Aysegul Ulu] Erciyes Univ, Fac Med, Kayseri, Turkey -- [Altay, Fatma Aybala] Diskapi Educ & Res Hosp, Ankara, Turkey -- [Altin, Nilgun -- Cesur, Salih] Ankara Etlik Educ & Res Hosp, Ankara, Turkey -- [Celik, Aygul Dogan] Trakya Univ, Fac Med, Edirne, Turkey -- [Dogan, Mustafa] Namik Kemal Univ, Fac Med, Tekirdag, Turkey -- [Duygu, Fazilet] Gaziosmanpasa Univ, Fac Med, Tokat, Turkey -- [Engin, Aynur] Cumhuriyet Univ, Fac Med, Sivas, Turkey -- [Gonen, Ibak] Suleyman Demirel Univ, Fac Med, TR-32200 Isparta, Turkey -- [Guven, Tumer] Ankara Ataturk Educ & Res Hosp, Ankara, Turkey -- [Hatipogiu, Cigdem Ataman] Ankara Educ & Res Hosp, Ankara, Turkey -- [Hosoglu, Salih] Dicle Univ, Fac Med, Diyarbakir, Turkey -- [Karahocagil, Mustafa Kasim] Yuzuncu Yil Univ, Fac Med, Van, Turkey -- [Ormen, Bahar] Izmir Ataturk Educ & Res Hosp, Izmir, Turkey -- [Ozdemir, Davut -- Sezak, Nurbanu -- Turker, Nesrin] Duzce Univ, Educ & Res Hosp, Duzce, Turkey -- [Oztoprak, Nefise] Antalya Educ & Res Hosp, Antalya, Turkey -- [Yilmaz, Hava] Ondokuz Mayis Univ, Fac Med, Samsun, Turkey, Durdu, Bulent -- 0000-0002-0244-4006, Karabay, Oguz -- 0000-0003-0502-432X, altay, fatma aybala -- 0000-0002-7149-2968, OMÜ, Balkan, Ilker Inanc, Batirel, Ayse, Karabay, Oguz, Agalar, Canan, Akalin, Serife, Alici, Ozlem, Alp, Emine, Altay, Fatma Aybala, Altin, Nilgun, Arslan, Ferhat, Aslan, Turan, Bekiroglu, Nural, Cesur, Salih, Celik, Aygul Dogan, Dogan, Mustafa, Durdu, Bulent, Duygu, Fazilet, Engin, Aynur, Engin, Derya Ozturk, Gonen, Ibak, Guciu, Ertugrul, Guven, Tumer, Hatipogiu, Cigdem Ataman, Hosoglu, Salih, Karahocagil, Mustafa Kasim, Kilic, Aysegul Ulu, Ormen, Bahar, Ozdemir, Davut, Ozer, Serdar, Oztoprak, Nefise, Sezak, Nurbanu, Turhan, Vedat, Turker, Nesrin, Yilmaz, Hava, Balkan, II, Batirel, A, Karabay, O, Agalar, C, Akalin, S, Alici, O, Alp, E, Altay, FA, Altin, N, Arslan, F, Aslan, T, Bekiroglu, N, Cesur, S, Celik, AD, Dogan, M, Durdu, B, Duygu, F, Engin, A, Engin, DO, Gonen, I, Guciu, E, Guven, T, Hatipogiu, CA, Hosoglu, S, Karahocagil, MK, Kilic, AU, Ormen, B, Ozdemir, D, Ozer, S, Oztoprak, N, Sezak, N, Turhan, V, Turker, N, Yilmaz, H, Sakarya Üniversitesi/Tıp Fakültesi/Dahili Tıp Bilimleri Bölümü, Karabay, Oğuz, and Güçlü, Ertuğrul

Subjects
Male, Kaplan Meier method, Turkey, retrospective study, proportional hazards model, Antibiotics, Bacteremia, Comorbidity, Tertiary Care Centers, middle aged, chi square distribution, Pharmacology (medical), colistin, comparative study, APACHE, Aged, 80 and over, OUTCOMES, Acinetobacter/*drug effects/pathogenicity, Acinetobacter Infections/*drug therapy/microbiology/mortality, Adolescent, Adult, Aged, Anti-Bacterial Agents/adverse effects/*therapeutic use, Bacteremia/*drug therapy/microbiology/mortality, Chi-Square Distribution, Colistin/adverse effects/*therapeutic use, Drug Resistance, Multiple, Bacterial, Drug Therapy, Combination, Female, Humans, Kaplan-Meier Estimate, Length of Stay, Middle Aged, Multivariate Ana, adult, Remission Induction, Appropriate, clinical trial, ANTIMICROBIAL THERAPY, multi drug resistant Acinetobacter spp, antiinfective agent, Pitt bacteremia score, aged, Impact, multivariate analysis, Sulbactam, risk factor, monotherapy, pathogen clearance, Baumannii Bacteremia, hospitalization, Acinetobacter Infections, medicine.medical_specialty, bloodstream infection, Article, multidrug resistance, multidrug resistant Acinetobacter bloodstream infection, human, treatment failure, Retrospective Studies, Pharmacology, Proportional hazards model, microbiology, medicine.disease, major clinical study, mortality, disease assessment, drug efficacy, multicenter study, RISK-FACTORS, TIGECYCLINE, Colistin, Acinetobacter infection, Pediatrics, BAUMANNII BACTEREMIA, Time Factors, IMPACT, very elderly, Critically-Ill Patients, Turkey (republic), Risk Factors, time factor, Risk-Factors, pathogenicity, Pharmacology & Pharmacy, Univariate analysis, biology, Acinetobacter, MATCHED COHORT, Anti-Bacterial Agents, Blood stream infection, female, Treatment Outcome, young adult, tertiary care center, CRITICALLY-ILL PATIENTS, Charlson Comorbidity Index, medicine.drug, Research Article, combination drug therapy, medicine.drug_class, Outcomes, Young Adult, remission, length of stay, Internal medicine, Gram-Negative Bacteria, medicine, follow up, controlled study, GRAM-NEGATIVE BACTERIA, A Multicenter retrospective analysis-, INDIAN JOURNAL OF PHARMACOLOGY, cilt.47, ss.95-100, 2015 [Balkan I. I. , BATIREL A., Karabay O., AGALAR C., Akalin S., ALICI O., Alp E., ALTAY F. A. , ALTIN N., Arslan F., et al., -Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections], Proportional Hazards Models, Antimicrobial Therapy, business.industry, Retrospective cohort study, Multi drug resistant Acinetobacter spp, biology.organism_classification, drug effects, Multivariate Analysis, business
Abstract

WOS: 000349144300018, PubMed ID: 25821319, Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A) . Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

Published
2015

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

Author

Turan Aslan, Cigdem Ataman Hatipoglu, Emine Alp, S. Cesur, Davut Ozdemir, N. Turker, Nilgün Altın, Ertugrul Guclu, Aysegul Ulu Kilic, Ilker Inanc Balkan, Salih Hosoglu, Nurbanu Sezak, Hava Yilmaz, Nefise Oztoprak, Tumer Guven, Serdar Özer, Bahar Ormen, Ayse Batirel, Derya Ozturk Engin, Aynur Engin, Ozlem Alici, Nuray Bekiroglu, Fazilet Duygu, Canan Agalar, Ibak Gonen, Mustafa Kasim Karahocagil, Oguz Karabay, Aygul Dogan Celik, Serife Akalin, Bülent Durdu, Mustafa Dogan, Ferhat Arslan, Fatma Aybala Altay, Vedat Turhan, Ondokuz Mayıs Üniversitesi, [Batirel, A. -- Ozer, S.] Kartal Dr Lutfi Kirdar Educ & Res Hosp, TR-34890 Istanbul, Turkey -- [Balkan, I. I.] Istanbul Univ, Cerrahpasa Med Fac, Istanbul, Turkey -- [Karabay, O. -- Guclu, E.] Sakarya Univ, Fac Med, Sakarya, Turkey -- [Agalar, C. -- Alici, O.] Fatih Sultan Mehmet Educ & Res Hosp, Istanbul, Turkey -- [Akalin, S.] Pamukkale Univ, Fac Med, Denizli, Turkey -- [Alp, E. -- Kilic, A. U.] Erciyes Univ, Fac Med, Kayseri, Turkey -- [Altay, F. A.] Diskapi Educ & Res Hosp, Ankara, Turkey -- [Altin, N. -- Cesur, S.] Ankara Etlik Educ & Res Hosp, Ankara, Turkey -- [Arslan, F.] Istanbul Medipol Univ, Fac Med, Istanbul, Turkey -- [Aslan, T.] Bezmi Alem Univ, Fac Med, Istanbul, Turkey -- [Bekiroglu, N.] Marmara Univ, Fac Med, Istanbul, Turkey -- [Celik, A. D.] Trakya Univ, Fac Med, Edirne, Turkey -- [Dogan, M.] Namik Kemal Univ, Fac Med, Tekirdag, Turkey -- [Durdu, B.] Bakirkoy Sadi Konuk Educ & Res Hosp, Istanbul, Turkey -- [Duygu, F.] Gaziosmanpasa Univ, Fac Med, Tokat, Turkey -- [Engin, A.] Cumhuriyet Univ, Fac Med, Sivas, Turkey -- [Engin, D. O.] Haydarpasa Numune Educ & Res Hosp, Istanbul, Turkey -- [Gonen, I.] Suleyman Demirel Univ, Fac Med, TR-32200 Isparta, Turkey -- [Guven, T.] Ankara Ataturk Educ & Res Hosp, Ankara, Turkey -- [Hatipoglu, C. A.] Ankara Educ & Res Hosp, Ankara, Turkey -- [Hosoglu, S.] Dicle Univ, Fac Med, Diyarbakir, Turkey -- [Karahocagil, M. K.] Yuzuncu Yil Univ, Fac Med, Van, Turkey -- [Ormen, B.] Izmir Ataturk Educ & Res Hosp, Izmir, Turkey -- [Ozdemir, D. -- Sezak, N. -- Turker, N.] Duzce Univ, Educ & Res Hosp, Duzce, Turkey -- [Oztoprak, N.] Antalya Educ & Res Hosp, Antalya, Turkey -- [Turhan, V.] GATA Haydarpasa Educ & Res Hosp, Istanbul, Turkey -- [Yilmaz, H.] Ondokuz Mayis Univ, Fac Med, Samsun, Turkey, altay, fatma aybala -- 0000-0002-7149-2968, Karabay, Oguz -- 0000-0003-0502-432X, Durdu, Bulent -- 0000-0002-0244-4006, and DURDU, BÜLENT

Subjects
Acinetobacter baumannii, Male, retrospective study, Bacteremia, intensive care unit, law.invention, meropenem, amikacin, neurotoxicity, middle aged, colistin, comparative study, health care economics and organizations, APACHE, APACHE II, adult, clinical trial, General Medicine, Sulbactam, Pitt bacteremia score, microbial sensitivity test, aged, priority journal, risk factor, drug withdrawal, monotherapy, Drug Therapy, Combination, tigecycline, Acinetobacter Infections, Colistin Plus, Microbiology (medical), survival rate, medicine.medical_specialty, education, drug combination, bloodstream infection, Microbial Sensitivity Tests, gentamicin, piperacillin plus tazobactam, concurrent infection, Colistin-Sulbactam, multidrug resistance, Humans, human, drug dose reduction, propensity score, Aged, Retrospective Studies, scoring system, treatment response, social sciences, Length of Stay, major clinical study, mortality, drug efficacy, multicenter study, Carbapenems, Colistin, eradication therapy, loading drug dose, Tigecycline, rifampicin, law, Risk Factors, Drug Resistance, Multiple, Bacterial, biology, Mortality rate, nephrotoxicity, article, Middle Aged, carbapenem derivative, Intensive care unit, aminoglycoside antibiotic agent, humanities, Infectious Diseases, female, Treatment Outcome, Colistin-Carbapenem, Female, Charlson Comorbidity Index, medicine.drug, Adult, sultamicillin, doripenem, netilmicin, carbapenem, length of stay, Internal medicine, medicine, nonhuman, business.industry, isolation and purification, Acinetobacter, biology.organism_classification, Surgery, Antibacterial, drug effects, business, human activities, imipenem
Abstract

23rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) -- 41394 -- Berlin, GERMANY, WOS: 000338723600006, PubMed ID: 24532009, 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.

Published
2014

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