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| Content Provider | Springer Nature Link |
|---|---|
| Author | 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. |
| Copyright Year | 2014 |
| 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. |
| Starting Page | 1311 |
| Ending Page | 1322 |
| Page Count | 12 |
| File Format | |
| ISSN | 09349723 |
| Journal | European Journal of Clinical Microbiology & Infectious Diseases |
| Volume Number | 33 |
| Issue Number | 8 |
| e-ISSN | 14354373 |
| Language | English |
| Publisher | Springer Berlin Heidelberg |
| Publisher Date | 2014-02-15 |
| Publisher Place | Berlin, Heidelberg |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Medical Microbiology Internal Medicine |
| Content Type | Text |
| Resource Type | Article |
| Subject | Infectious Diseases Microbiology (medical) |
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