title: Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections.
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.
authors: Infectious Diseases and Clinical Microbiology, Kartal Dr. Lutfi Kirdar Education and Research Hospital, Semsi Denizer Cd. E-5 Karayolu Cevizli Mevkii, 34890, Kartal, Istanbul, Turkey, aysebatirel@yahoo.com.
authors: A
authors: A
authors: Batirel
authors: I I
authors: II
authors: Balkan
authors: O
authors: O
authors: Karabay
authors: C
authors: C
authors: Agalar
authors: S
authors: S
authors: Akalin
authors: O
authors: O
authors: Alici
authors: E
authors: E
authors: Alp
authors: F A
authors: FA
authors: Altay
authors: N
authors: N
authors: Altin
authors: F
authors: F
authors: Arslan
authors: T
authors: T
authors: Aslan
authors: N
authors: N
authors: Bekiroglu
authors: S
authors: S
authors: Cesur
authors: A D
authors: AD
authors: Celik
authors: M
authors: M
authors: Dogan
authors: B
authors: B
authors: Durdu
authors: F
authors: F
authors: Duygu
authors: A
authors: A
authors: Engin
authors: D O
authors: DO
authors: Engin
authors: I
authors: I
authors: Gonen
authors: E
authors: E
authors: Guclu
authors: T
authors: T
authors: Guven
authors: C A
authors: CA
authors: Hatipoglu
authors: S
authors: S
authors: Hosoglu
authors: M K
authors: MK
authors: Karahocagil
authors: A U
authors: AU
authors: Kilic
authors: B
authors: B
authors: Ormen
authors: D
authors: D
authors: Ozdemir
authors: S
authors: S
authors: Ozer
authors: N
authors: N
authors: Oztoprak
authors: N
authors: N
authors: Sezak
authors: V
authors: V
authors: Turhan
authors: N
authors: N
authors: Turker
authors: H
authors: H
authors: Yilmaz
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy*; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use*; D003091:Colistin / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013407:Sulbactam / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015780:Carbapenems; D013407:Sulbactam; D003091:Colistin