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

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-d... Full description

Journal Title: European journal of clinical microbiology & infectious diseases 2014-02-15, Vol.33 (8), p.1311-1322
Main Author: Batirel, A
Other Authors: Balkan, I. I , Karabay, O , Agalar, C , Akalin, S , Alici, O , Alp, E , Altay, F. A , Altin, N , Arslan, F , Aslan, T , Bekiroglu, N , Cesur, S , Celik, A. D , Dogan, M , Durdu, B , Duygu, F , Engin, A , Engin, D. O , Gonen, I , Guclu, E , Guven, T , Hatipoglu, C. A , Hosoglu, S , Karahocagil, M. K , Kilic, A. U , Ormen, B , Ozdemir, D , Ozer, S , Oztoprak, N , Sezak, N , Turhan, V , Turker, N , Yilmaz, H
Format: Electronic Article Electronic Article
Language: English
Subjects:
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
ID: ISSN: 0934-9723
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title: Comparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
format: Article
creator:
  • Batirel, A
  • Balkan, I. I
  • Karabay, O
  • Agalar, C
  • Akalin, S
  • Alici, O
  • Alp, E
  • Altay, F. A
  • Altin, N
  • Arslan, F
  • Aslan, T
  • Bekiroglu, N
  • Cesur, S
  • Celik, A. D
  • Dogan, M
  • Durdu, B
  • Duygu, F
  • Engin, A
  • Engin, D. O
  • Gonen, I
  • Guclu, E
  • Guven, T
  • Hatipoglu, C. A
  • Hosoglu, S
  • Karahocagil, M. K
  • Kilic, A. U
  • Ormen, B
  • Ozdemir, D
  • Ozer, S
  • Oztoprak, N
  • Sezak, N
  • Turhan, V
  • Turker, N
  • Yilmaz, H
subjects:
  • Acinetobacter
  • Acinetobacter baumannii
  • Acinetobacter baumannii - drug effects
  • Acinetobacter baumannii - isolation & purification
  • Acinetobacter Infections
  • Acinetobacter Infections - drug therapy
  • Adult
  • Aged
  • amikacin
  • aminoglycoside antibiotic agent
  • Antibacterial agents
  • Antibiotics. Antiinfectious agents. Antiparasitic agents
  • Article
  • Bacteremia
  • Bacteremia - drug therapy
  • Bacterial
  • Bacterial diseases
  • Bacterial sepsis
  • Biological and medical sciences
  • Biomedical and Life Sciences
  • Biomedicine
  • bloodstream infection
  • carbapenem
  • carbapenem derivative
  • Carbapenems
  • Carbapenems - pharmacology
  • Carbapenems - therapeutic use
  • Charlson Comorbidity Index
  • clinical trial
  • Colistin
  • Colistin - pharmacology
  • Colistin - therapeutic use
  • Combination
  • Comparative analysis
  • comparative study
  • concurrent infection
  • doripenem
  • drug combination
  • drug dose reduction
  • drug effects
  • drug efficacy
  • Drug Resistance
  • Drug Resistance, Multiple, Bacterial
  • Drug Therapy
  • Drug Therapy, Combination
  • drug withdrawal
  • eradication therapy
  • Female
  • gentamicin
  • Health aspects
  • human
  • Human bacterial diseases
  • Humans
  • imipenem
  • Infectious diseases
  • intensive care unit
  • Internal Medicine
  • isolation
  • Length of Stay
  • loading drug dose
  • major clinical study
  • Male
  • Medical Microbiology
  • Medical sciences
  • meropenem
  • microbial sensitivity test
  • Microbial Sensitivity Tests
  • Middle Aged
  • monotherapy
  • mortality
  • multicenter study
  • multidrug resistance
  • Multiple
  • nephrotoxicity
  • netilmicin
  • neurotoxicity
  • nonhuman
  • Pharmacology. Drug treatments
  • piperacillin plus tazobactam
  • Pitt bacteremia score
  • priority journal
  • propensity score
  • purification
  • Retrospective Studies
  • retrospective study
  • rifampicin
  • risk factor
  • Risk Factors
  • scoring system
  • Sulbactam
  • Sulbactam - pharmacology
  • Sulbactam - therapeutic use
  • sultamicillin
  • survival rate
  • tigecycline
  • Treatment Outcome
  • treatment response
ispartof: European journal of clinical microbiology & infectious diseases, 2014-02-15, Vol.33 (8), p.1311-1322
description: 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  
language: eng
source:
identifier: ISSN: 0934-9723
fulltext: no_fulltext
issn:
  • 0934-9723
  • 1435-4373
url: Link


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titleComparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
creatorBatirel, A ; Balkan, I. I ; Karabay, O ; Agalar, C ; Akalin, S ; Alici, O ; Alp, E ; Altay, F. A ; Altin, N ; Arslan, F ; Aslan, T ; Bekiroglu, N ; Cesur, S ; Celik, A. D ; Dogan, M ; Durdu, B ; Duygu, F ; Engin, A ; Engin, D. O ; Gonen, I ; Guclu, E ; Guven, T ; Hatipoglu, C. A ; Hosoglu, S ; Karahocagil, M. K ; Kilic, A. U ; Ormen, B ; Ozdemir, D ; Ozer, S ; Oztoprak, N ; Sezak, N ; Turhan, V ; Turker, N ; Yilmaz, H
creatorcontribBatirel, A ; Balkan, I. I ; Karabay, O ; Agalar, C ; Akalin, S ; Alici, O ; Alp, E ; Altay, F. A ; Altin, N ; Arslan, F ; Aslan, T ; Bekiroglu, N ; Cesur, S ; Celik, A. D ; Dogan, M ; Durdu, B ; Duygu, F ; Engin, A ; Engin, D. O ; Gonen, I ; Guclu, E ; Guven, T ; Hatipoglu, C. A ; Hosoglu, S ; Karahocagil, M. K ; Kilic, A. U ; Ormen, B ; Ozdemir, D ; Ozer, S ; Oztoprak, N ; Sezak, N ; Turhan, V ; Turker, N ; Yilmaz, H
descriptionThe 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.
identifier
0ISSN: 0934-9723
1EISSN: 1435-4373
2DOI: 10.1007/s10096-014-2070-6
3PMID: 24532009
languageeng
publisherBerlin/Heidelberg: Springer Berlin Heidelberg
subjectAcinetobacter ; Acinetobacter baumannii ; Acinetobacter baumannii - drug effects ; Acinetobacter baumannii - isolation & purification ; Acinetobacter Infections ; Acinetobacter Infections - drug therapy ; Adult ; Aged ; amikacin ; aminoglycoside antibiotic agent ; Antibacterial agents ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Article ; Bacteremia ; Bacteremia - drug therapy ; Bacterial ; Bacterial diseases ; Bacterial sepsis ; Biological and medical sciences ; Biomedical and Life Sciences ; Biomedicine ; bloodstream infection ; carbapenem ; carbapenem derivative ; Carbapenems ; Carbapenems - pharmacology ; Carbapenems - therapeutic use ; Charlson Comorbidity Index ; clinical trial ; Colistin ; Colistin - pharmacology ; Colistin - therapeutic use ; Combination ; Comparative analysis ; comparative study ; concurrent infection ; doripenem ; drug combination ; drug dose reduction ; drug effects ; drug efficacy ; Drug Resistance ; Drug Resistance, Multiple, Bacterial ; Drug Therapy ; Drug Therapy, Combination ; drug withdrawal ; eradication therapy ; Female ; gentamicin ; Health aspects ; human ; Human bacterial diseases ; Humans ; imipenem ; Infectious diseases ; intensive care unit ; Internal Medicine ; isolation ; Length of Stay ; loading drug dose ; major clinical study ; Male ; Medical Microbiology ; Medical sciences ; meropenem ; microbial sensitivity test ; Microbial Sensitivity Tests ; Middle Aged ; monotherapy ; mortality ; multicenter study ; multidrug resistance ; Multiple ; nephrotoxicity ; netilmicin ; neurotoxicity ; nonhuman ; Pharmacology. Drug treatments ; piperacillin plus tazobactam ; Pitt bacteremia score ; priority journal ; propensity score ; purification ; Retrospective Studies ; retrospective study ; rifampicin ; risk factor ; Risk Factors ; scoring system ; Sulbactam ; Sulbactam - pharmacology ; Sulbactam - therapeutic use ; sultamicillin ; survival rate ; tigecycline ; Treatment Outcome ; treatment response
ispartofEuropean journal of clinical microbiology & infectious diseases, 2014-02-15, Vol.33 (8), p.1311-1322
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0Batirel, A
1Balkan, I. I
2Karabay, O
3Agalar, C
4Akalin, S
5Alici, O
6Alp, E
7Altay, F. A
8Altin, N
9Arslan, F
10Aslan, T
11Bekiroglu, N
12Cesur, S
13Celik, A. D
14Dogan, M
15Durdu, B
16Duygu, F
17Engin, A
18Engin, D. O
19Gonen, I
20Guclu, E
21Guven, T
22Hatipoglu, C. A
23Hosoglu, S
24Karahocagil, M. K
25Kilic, A. U
26Ormen, B
27Ozdemir, D
28Ozer, S
29Oztoprak, N
30Sezak, N
31Turhan, V
32Turker, N
33Yilmaz, H
title
0Comparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
1European journal of clinical microbiology & infectious diseases
addtitle
0Eur J Clin Microbiol Infect Dis
1Eur J Clin Microbiol Infect Dis
descriptionThe 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.
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0Acinetobacter
1Acinetobacter baumannii
2Acinetobacter baumannii - drug effects
3Acinetobacter baumannii - isolation & purification
4Acinetobacter Infections
5Acinetobacter Infections - drug therapy
6Adult
7Aged
8amikacin
9aminoglycoside antibiotic agent
10Antibacterial agents
11Antibiotics. Antiinfectious agents. Antiparasitic agents
12Article
13Bacteremia
14Bacteremia - drug therapy
15Bacterial
16Bacterial diseases
17Bacterial sepsis
18Biological and medical sciences
19Biomedical and Life Sciences
20Biomedicine
21bloodstream infection
22carbapenem
23carbapenem derivative
24Carbapenems
25Carbapenems - pharmacology
26Carbapenems - therapeutic use
27Charlson Comorbidity Index
28clinical trial
29Colistin
30Colistin - pharmacology
31Colistin - therapeutic use
32Combination
33Comparative analysis
34comparative study
35concurrent infection
36doripenem
37drug combination
38drug dose reduction
39drug effects
40drug efficacy
41Drug Resistance
42Drug Resistance, Multiple, Bacterial
43Drug Therapy
44Drug Therapy, Combination
45drug withdrawal
46eradication therapy
47Female
48gentamicin
49Health aspects
50human
51Human bacterial diseases
52Humans
53imipenem
54Infectious diseases
55intensive care unit
56Internal Medicine
57isolation
58Length of Stay
59loading drug dose
60major clinical study
61Male
62Medical Microbiology
63Medical sciences
64meropenem
65microbial sensitivity test
66Microbial Sensitivity Tests
67Middle Aged
68monotherapy
69mortality
70multicenter study
71multidrug resistance
72Multiple
73nephrotoxicity
74netilmicin
75neurotoxicity
76nonhuman
77Pharmacology. Drug treatments
78piperacillin plus tazobactam
79Pitt bacteremia score
80priority journal
81propensity score
82purification
83Retrospective Studies
84retrospective study
85rifampicin
86risk factor
87Risk Factors
88scoring system
89Sulbactam
90Sulbactam - pharmacology
91Sulbactam - therapeutic use
92sultamicillin
93survival rate
94tigecycline
95Treatment Outcome
96treatment response
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6Alp, E
7Altay, F. A
8Altin, N
9Arslan, F
10Aslan, T
11Bekiroglu, N
12Cesur, S
13Celik, A. D
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15Durdu, B
16Duygu, F
17Engin, A
18Engin, D. O
19Gonen, I
20Guclu, E
21Guven, T
22Hatipoglu, C. A
23Hosoglu, S
24Karahocagil, M. K
25Kilic, A. U
26Ormen, B
27Ozdemir, D
28Ozer, S
29Oztoprak, N
30Sezak, N
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titleComparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
authorBatirel, A ; Balkan, I. I ; Karabay, O ; Agalar, C ; Akalin, S ; Alici, O ; Alp, E ; Altay, F. A ; Altin, N ; Arslan, F ; Aslan, T ; Bekiroglu, N ; Cesur, S ; Celik, A. D ; Dogan, M ; Durdu, B ; Duygu, F ; Engin, A ; Engin, D. O ; Gonen, I ; Guclu, E ; Guven, T ; Hatipoglu, C. A ; Hosoglu, S ; Karahocagil, M. K ; Kilic, A. U ; Ormen, B ; Ozdemir, D ; Ozer, S ; Oztoprak, N ; Sezak, N ; Turhan, V ; Turker, N ; Yilmaz, H
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0Acinetobacter
1Acinetobacter baumannii
2Acinetobacter baumannii - drug effects
3Acinetobacter baumannii - isolation & purification
4Acinetobacter Infections
5Acinetobacter Infections - drug therapy
6Adult
7Aged
8amikacin
9aminoglycoside antibiotic agent
10Antibacterial agents
11Antibiotics. Antiinfectious agents. Antiparasitic agents
12Article
13Bacteremia
14Bacteremia - drug therapy
15Bacterial
16Bacterial diseases
17Bacterial sepsis
18Biological and medical sciences
19Biomedical and Life Sciences
20Biomedicine
21bloodstream infection
22carbapenem
23carbapenem derivative
24Carbapenems
25Carbapenems - pharmacology
26Carbapenems - therapeutic use
27Charlson Comorbidity Index
28clinical trial
29Colistin
30Colistin - pharmacology
31Colistin - therapeutic use
32Combination
33Comparative analysis
34comparative study
35concurrent infection
36doripenem
37drug combination
38drug dose reduction
39drug effects
40drug efficacy
41Drug Resistance
42Drug Resistance, Multiple, Bacterial
43Drug Therapy
44Drug Therapy, Combination
45drug withdrawal
46eradication therapy
47Female
48gentamicin
49Health aspects
50human
51Human bacterial diseases
52Humans
53imipenem
54Infectious diseases
55intensive care unit
56Internal Medicine
57isolation
58Length of Stay
59loading drug dose
60major clinical study
61Male
62Medical Microbiology
63Medical sciences
64meropenem
65microbial sensitivity test
66Microbial Sensitivity Tests
67Middle Aged
68monotherapy
69mortality
70multicenter study
71multidrug resistance
72Multiple
73nephrotoxicity
74netilmicin
75neurotoxicity
76nonhuman
77Pharmacology. Drug treatments
78piperacillin plus tazobactam
79Pitt bacteremia score
80priority journal
81propensity score
82purification
83Retrospective Studies
84retrospective study
85rifampicin
86risk factor
87Risk Factors
88scoring system
89Sulbactam
90Sulbactam - pharmacology
91Sulbactam - therapeutic use
92sultamicillin
93survival rate
94tigecycline
95Treatment Outcome
96treatment response
toplevelpeer_reviewed
creatorcontrib
0Batirel, A
1Balkan, I. I
2Karabay, O
3Agalar, C
4Akalin, S
5Alici, O
6Alp, E
7Altay, F. A
8Altin, N
9Arslan, F
10Aslan, T
11Bekiroglu, N
12Cesur, S
13Celik, A. D
14Dogan, M
15Durdu, B
16Duygu, F
17Engin, A
18Engin, D. O
19Gonen, I
20Guclu, E
21Guven, T
22Hatipoglu, C. A
23Hosoglu, S
24Karahocagil, M. K
25Kilic, A. U
26Ormen, B
27Ozdemir, D
28Ozer, S
29Oztoprak, N
30Sezak, N
31Turhan, V
32Turker, N
33Yilmaz, H
collection
0Pascal-Francis
1Medline
2MEDLINE
3MEDLINE (Ovid)
4MEDLINE
5MEDLINE
6PubMed
7CrossRef
8Academic OneFile (A&I only)
9ProQuest Central (Corporate)
10Bacteriology Abstracts (Microbiology B)
11Virology and AIDS Abstracts
12Health & Medical Collection
13ProQuest Central (purchase pre-March 2016)
14Biology Database (Alumni Edition)
15Medical Database (Alumni Edition)
16ProQuest Pharma Collection
17ProQuest SciTech Collection
18ProQuest Natural Science Collection
19Hospital Premium Collection
20Hospital Premium Collection (Alumni Edition)
21ProQuest Central (Alumni) (purchase pre-March 2016)
22ProQuest Central (Alumni Edition)
23ProQuest Central Essentials
24Biological Science Collection
25ProQuest Central
26Natural Science Collection
27Environmental Sciences and Pollution Management
28ProQuest Central Korea
29Health Research Premium Collection
30Health Research Premium Collection (Alumni)
31ProQuest Central Student
32AIDS and Cancer Research Abstracts
33SciTech Premium Collection
34ProQuest Health & Medical Complete (Alumni)
35ProQuest Biological Science Collection
36Health & Medical Collection (Alumni Edition)
37Medical Database
38Algology Mycology and Protozoology Abstracts (Microbiology C)
39Biological Science Database
40ProQuest One Academic Eastern Edition
41ProQuest One Academic
42ProQuest One Academic UKI Edition
43ProQuest Central China
44Industrial and Applied Microbiology Abstracts (Microbiology A)
45Technology Research Database
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48OpenAIRE (Open Access)
49OpenAIRE
jtitleEuropean journal of clinical microbiology & infectious diseases
delivery
delcategoryRemote Search Resource
fulltextno_fulltext
addata
au
0Batirel, A
1Balkan, I. I
2Karabay, O
3Agalar, C
4Akalin, S
5Alici, O
6Alp, E
7Altay, F. A
8Altin, N
9Arslan, F
10Aslan, T
11Bekiroglu, N
12Cesur, S
13Celik, A. D
14Dogan, M
15Durdu, B
16Duygu, F
17Engin, A
18Engin, D. O
19Gonen, I
20Guclu, E
21Guven, T
22Hatipoglu, C. A
23Hosoglu, S
24Karahocagil, M. K
25Kilic, A. U
26Ormen, B
27Ozdemir, D
28Ozer, S
29Oztoprak, N
30Sezak, N
31Turhan, V
32Turker, N
33Yilmaz, H
formatjournal
genrearticle
ristypeJOUR
atitleComparison of colistin–carbapenem, colistin–sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
jtitleEuropean journal of clinical microbiology & infectious diseases
stitleEur J Clin Microbiol Infect Dis
addtitleEur J Clin Microbiol Infect Dis
date2014-02-15
risdate2014
volume33
issue8
spage1311
epage1322
pages1311-1322
issn0934-9723
eissn1435-4373
abstractThe 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.
copBerlin/Heidelberg
pubSpringer Berlin Heidelberg
pmid24532009
doi10.1007/s10096-014-2070-6
oafree_for_read