Back to Search
Start Over
Multicentre study of risk factors for mortality in patients with Acinetobacter bacteraemia receiving colistin treatment.
- Source :
-
International journal of antimicrobial agents [Int J Antimicrob Agents] 2020 Jun; Vol. 55 (6), pp. 105956. Date of Electronic Publication: 2020 Apr 09. - Publication Year :
- 2020
-
Abstract
- Colistin remains a last-line antibiotic for the treatment of infections by multidrug-resistant Acinetobacter species. However, mortality rates are high in patients with Acinetobacter infection receiving colistin treatment. This multicentre study evaluated whether colistin susceptibility, additional antimicrobial agents or other prognostic factors influenced the clinical outcomes of patients receiving colistin treatment for Acinetobacter bacteraemia. This retrospective study enrolled 122 adults receiving colistin for monomicrobial Acinetobacter bacteraemia at six medical centres in the ACTION Study Group over an 8-year period. Clinical information, antimicrobial susceptibility and colistin resistance determinants were analysed. The primary outcome measure was 14-day mortality. Among 122 patients, 18 and 104 were infected with colistin-resistant (ColR) isolates [minimum inhibitory concentration (MIC) ≥4 mg/L] and colistin-susceptible (ColS) isolates (MIC ≤2 mg/L), respectively. Patients infected with ColR and ColS isolates did not differ significantly with regard to Charlson comorbidity index, invasive procedures, sources of bacteraemia, disease severity and 14-day mortality rate (44.4% vs. 34.6%; P = 0.592). No specific additional antimicrobial agent was independently associated with higher or lower mortality. Coronary artery disease, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score and bacteraemia caused Acinetobacter baumannii were independent risk factors associated with 14-day mortality. Mechanisms of colistin resistance were associated with amino acid variants in the pmrCAB operon. Finally, previously unreported Acinetobacter nosocomialis amino acid variants related to colistin resistance were identified. In conclusion, colistin susceptibility and colistin combination antimicrobial treatment were not associated with decreased 14-day mortality in patients with Acinetobacter bacteraemia receiving colistin treatment.<br /> (Copyright © 2020 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
- Subjects :
- Acinetobacter genetics
Acinetobacter Infections microbiology
Acinetobacter baumannii drug effects
Acinetobacter baumannii genetics
Aged
Aged, 80 and over
Anti-Bacterial Agents therapeutic use
Bacteremia drug therapy
Bacteremia mortality
Comorbidity
Drug Resistance, Bacterial
Female
Genome, Bacterial
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Operon
Prognosis
Retrospective Studies
Risk Factors
Treatment Outcome
Acinetobacter drug effects
Acinetobacter Infections drug therapy
Acinetobacter Infections mortality
Colistin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7913
- Volume :
- 55
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- International journal of antimicrobial agents
- Publication Type :
- Academic Journal
- Accession number :
- 32278810
- Full Text :
- https://doi.org/10.1016/j.ijantimicag.2020.105956