title: Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: a multicenter retrospective analysis.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included.
  
  
  METHODS
  14-day mortality.
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Ilker Inanc
authors.initials: II
authors.lastname: Balkan
authors.affiliation: Kartal Dr. Lutfi Kirdar Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Batirel
authors.affiliation: Sakarya University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
authors.forename: Oguz
authors.initials: O
authors.lastname: Karabay
authors.affiliation: Fatih Sultan Mehmet Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Canan
authors.initials: C
authors.lastname: Agalar
authors.affiliation: Pamukkale University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Denizli, Turkey.
authors.forename: Serife
authors.initials: S
authors.lastname: Akalin
authors.affiliation: Fatih Sultan Mehmet Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Alici
authors.affiliation: Erciyes University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Kayseri, Turkey.
authors.forename: Emine
authors.initials: E
authors.lastname: Alp
authors.affiliation: Diskapi Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Fatma Aybala
authors.initials: FA
authors.lastname: Altay
authors.affiliation: Ankara Etlik Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Nilgun
authors.initials: N
authors.lastname: Altin
authors.affiliation: Istanbul Medipol University, Medical Faculty, Infectious Diseases, Istanbul, Turkey.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Arslan
authors.affiliation: Bezmi Alem University, Medical Faculty, Infectious Diseases, Istanbul, Turkey.
authors.forename: Turan
authors.initials: T
authors.lastname: Aslan
authors.affiliation: Marmara University, Medical Faculty, Biostatistics, Istanbul, Turkey.
authors.forename: Nural
authors.initials: N
authors.lastname: Bekiroglu
authors.affiliation: Ankara Etlik Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Cesur
authors.affiliation: Trakya University, Medical Faculty, Infectious Diseases, Edirne, Turkey.
authors.forename: Aygul Dogan
authors.initials: AD
authors.lastname: Celik
authors.affiliation: Namik Kemal University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Tekirdag, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Dogan
authors.affiliation: Bakirkoy Sadi Konuk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Bulent
authors.initials: B
authors.lastname: Durdu
authors.affiliation: Gaziosmanpasa University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Tokat, Turkey.
authors.forename: Fazilet
authors.initials: F
authors.lastname: Duygu
authors.affiliation: Cumhuriyet University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sivas, Turkey.
authors.forename: Aynur
authors.initials: A
authors.lastname: Engin
authors.affiliation: Haydarpasa Numune Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Derya Ozturk
authors.initials: DO
authors.lastname: Engin
authors.affiliation: Suleyman Demirel University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Isparta, Turkey.
authors.forename: Ibak
authors.initials: I
authors.lastname: Gonen
authors.affiliation: Sakarya University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey.
authors.forename: Ertugrul
authors.initials: E
authors.lastname: Guclu
authors.affiliation: Ankara Ataturk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Tumer
authors.initials: T
authors.lastname: Guven
authors.affiliation: Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey.
authors.forename: Cigdem Ataman
authors.initials: CA
authors.lastname: Hatipoglu
authors.affiliation: Dicle University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey.
authors.forename: Salih
authors.initials: S
authors.lastname: Hosoglu
authors.affiliation: Yuzuncu Yil University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Van, Turkey.
authors.forename: Mustafa Kasim
authors.initials: MK
authors.lastname: Karahocagil
authors.affiliation: Erciyes University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Kayseri, Turkey.
authors.forename: Aysegul Ulu
authors.initials: AU
authors.lastname: Kilic
authors.affiliation: Izmir Ataturk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Izmir, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Ormen
authors.affiliation: Duzce University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Düzce, Turkey.
authors.forename: Davut
authors.initials: D
authors.lastname: Ozdemir
authors.affiliation: Kartal Dr. Lutfi Kirdar Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Serdar
authors.initials: S
authors.lastname: Ozer
authors.affiliation: Antalya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Antalya, Turkey.
authors.forename: Nefise
authors.initials: N
authors.lastname: Oztoprak
authors.affiliation: Duzce University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Düzce, Turkey.
authors.forename: Nurbanu
authors.initials: N
authors.lastname: Sezak
authors.affiliation: GATA Haydarpasa Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Turhan
authors.affiliation: Duzce University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Düzce, Turkey.
authors.forename: Nesrin
authors.initials: N
authors.lastname: Turker
authors.affiliation: Ondokuz Mayıs University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Samsun, Turkey.
authors.forename: Hava
authors.initials: H
authors.lastname: Yilmaz
mesh_terms: D018806:APACHE; D000150:Acinetobacter / Q000187:drug effects* / Q000472:pathogenicity; D000151:Acinetobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality; D016009:Chi-Square Distribution; D003091:Colistin / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D003091:Colistin
keywords: Blood stream infection; colistin; monotherapy; multi drug resistant Acinetobacter spp.
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