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

来源：

EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES | 2014年 / 33卷 / 08期

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

页码：1311 / 1322

页数：12

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