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

被引:131
作者
Batirel, A. [1 ]
Balkan, I. I. [2 ]
Karabay, O. [3 ]
Agalar, C. [4 ]
Akalin, S. [5 ]
Alici, O. [4 ]
Alp, E. [6 ]
Altay, F. A. [7 ]
Altin, N. [8 ]
Arslan, F. [9 ]
Aslan, T. [10 ]
Bekiroglu, N. [11 ]
Cesur, S. [8 ]
Celik, A. D. [12 ]
Dogan, M. [13 ]
Durdu, B. [14 ]
Duygu, F. [15 ]
Engin, A. [16 ]
Engin, D. O. [17 ]
Gonen, I. [18 ]
Guclu, E. [3 ]
Guven, T. [19 ]
Hatipoglu, C. A. [20 ]
Hosoglu, S. [21 ]
Karahocagil, M. K. [22 ]
Kilic, A. U. [6 ]
Ormen, B. [23 ]
Ozdemir, D. [24 ]
Ozer, S. [1 ]
Oztoprak, N. [25 ]
Sezak, N. [24 ]
Turhan, V. [26 ]
Turker, N. [24 ]
Yilmaz, H. [27 ]
机构
[1] Kartal Dr Lutfi Kirdar Educ & Res Hosp, TR-34890 Istanbul, Turkey
[2] Istanbul Univ, Cerrahpasa Med Fac, Istanbul, Turkey
[3] Sakarya Univ, Fac Med, Sakarya, Turkey
[4] Fatih Sultan Mehmet Educ & Res Hosp, Istanbul, Turkey
[5] Pamukkale Univ, Fac Med, Denizli, Turkey
[6] Erciyes Univ, Fac Med, Kayseri, Turkey
[7] Diskapi Educ & Res Hosp, Ankara, Turkey
[8] Ankara Etlik Educ & Res Hosp, Ankara, Turkey
[9] Istanbul Medipol Univ, Fac Med, Istanbul, Turkey
[10] Bezmi Alem Univ, Fac Med, Istanbul, Turkey
[11] Marmara Univ, Fac Med, Istanbul, Turkey
[12] Trakya Univ, Fac Med, Edirne, Turkey
[13] Namik Kemal Univ, Fac Med, Tekirdag, Turkey
[14] Bakirkoy Sadi Konuk Educ & Res Hosp, Istanbul, Turkey
[15] Gaziosmanpasa Univ, Fac Med, Tokat, Turkey
[16] Cumhuriyet Univ, Fac Med, Sivas, Turkey
[17] Haydarpasa Numune Educ & Res Hosp, Istanbul, Turkey
[18] Suleyman Demirel Univ, Fac Med, TR-32200 Isparta, Turkey
[19] Ankara Ataturk Educ & Res Hosp, Ankara, Turkey
[20] Ankara Educ & Res Hosp, Ankara, Turkey
[21] Dicle Univ, Fac Med, Diyarbakir, Turkey
[22] Yuzuncu Yil Univ, Fac Med, Van, Turkey
[23] Izmir Ataturk Educ & Res Hosp, Izmir, Turkey
[24] Duzce Univ, Educ & Res Hosp, Duzce, Turkey
[25] Antalya Educ & Res Hosp, Antalya, Turkey
[26] GATA Haydarpasa Educ & Res Hosp, Istanbul, Turkey
[27] Ondokuz Mayis Univ, Fac Med, Samsun, Turkey
关键词
APPROPRIATE ANTIMICROBIAL THERAPY; IN-VITRO; ANTIBIOTIC COMBINATIONS; PSEUDOMONAS-AERUGINOSA; SERIOUS INFECTIONS; APACHE-II; BACTEREMIA; RIFAMPICIN; PNEUMONIA; MORTALITY;
D O I
10.1007/s10096-014-2070-6
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
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.
引用
收藏
页码:1311 / 1322
页数:12
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