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

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.

• Authors: Ilker Inanc Balkan, Ayse Batirel, Oguz Karabay, Canan Agalar, Serife Akalin, Ozlem Alici, Emine Alp, Fatma Aybala Altay, Nilgun Altin, Ferhat Arslan, Turan Aslan, Nural Bekiroglu, Salih Cesur, Aygul Dogan Celik, Mustafa Dogan, Bulent Durdu, Fazilet Duygu, Aynur Engin, Derya Ozturk Engin, Ibak Gonen, Ertugrul Guclu, Tumer Guven, Cigdem Ataman Hatipoglu, Salih Hosoglu, Mustafa Kasim Karahocagil, Aysegul Ulu Kilic, Bahar Ormen, Davut Ozdemir, Serdar Ozer, Nefise Oztoprak, Nurbanu Sezak, Vedat Turhan, Nesrin Turker, Hava Yilmaz
• Journal: Indian journal of pharmacology (Indian J Pharmacol) 2015 Jan-Feb Vol. 47 Issue 1 Pg. 95-100 ISSN: 1998-3751 [Electronic] India
• PMID: 25821319 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Observational Study)

Chemical References

• Anti-Bacterial Agents
• Colistin

Topics

• APACHE
• Acinetobacter (drug effects, pathogenicity)
• Acinetobacter Infections (drug therapy, microbiology, mortality)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (adverse effects, therapeutic use)
• Bacteremia (drug therapy, microbiology, mortality)
• Chi-Square Distribution
• Colistin (adverse effects, therapeutic use)
• Comorbidity
• Drug Resistance, Multiple, Bacterial
• Drug Therapy, Combination
• Female
• Humans
• Kaplan-Meier Estimate
• Length of Stay
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Remission Induction
• Retrospective Studies
• Risk Factors
• Tertiary Care Centers
• Time Factors
• Treatment Outcome
• Turkey
• Young Adult