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

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, Yilmaz H - Indian J Pharmacol (2015 Jan-Feb)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

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.

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Related in: MedlinePlus

The distribution of cases within treatment groups (CES: Cefoperazone-sulbactam, AG: Aminoglycoside, CAR: Carbapenem, TIG: Tigecycline, SULB: Sulbactam, QUIN: Quinolone, TPZ: Piperacilln/tazobactam, RIF: Rifampin, FEP: Cefepime
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Figure 1: The distribution of cases within treatment groups (CES: Cefoperazone-sulbactam, AG: Aminoglycoside, CAR: Carbapenem, TIG: Tigecycline, SULB: Sulbactam, QUIN: Quinolone, TPZ: Piperacilln/tazobactam, RIF: Rifampin, FEP: Cefepime

Mentions: A total of 107 consecutive patients, 102 of whom followed in the ICUs within a certain period of time, 36 treated with CM and 71 treated with non-COL based combinations (NCC) were included in the study. The consort diagram of the distribution of patients within the two treatment groups is shown in Figure 1. The median duration of follow-up was 40 days (range: 9–297). Rate of treatment success was 77.1% in CM and 77.2% in NCC group (P = 0.45).


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

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, Yilmaz H - Indian J Pharmacol (2015 Jan-Feb)

The distribution of cases within treatment groups (CES: Cefoperazone-sulbactam, AG: Aminoglycoside, CAR: Carbapenem, TIG: Tigecycline, SULB: Sulbactam, QUIN: Quinolone, TPZ: Piperacilln/tazobactam, RIF: Rifampin, FEP: Cefepime
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4375827&req=5

Figure 1: The distribution of cases within treatment groups (CES: Cefoperazone-sulbactam, AG: Aminoglycoside, CAR: Carbapenem, TIG: Tigecycline, SULB: Sulbactam, QUIN: Quinolone, TPZ: Piperacilln/tazobactam, RIF: Rifampin, FEP: Cefepime
Mentions: A total of 107 consecutive patients, 102 of whom followed in the ICUs within a certain period of time, 36 treated with CM and 71 treated with non-COL based combinations (NCC) were included in the study. The consort diagram of the distribution of patients within the two treatment groups is shown in Figure 1. The median duration of follow-up was 40 days (range: 9–297). Rate of treatment success was 77.1% in CM and 77.2% in NCC group (P = 0.45).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.

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.

Show MeSH
Related in: MedlinePlus