dc.description.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. | en_US |
dc.contributor.department | [Batirel, A. -- Ozer, S.] Kartal Dr Lutfi Kirdar Educ & Res Hosp, TR-34890 Istanbul, Turkey -- [Balkan, I. I.] Istanbul Univ, Cerrahpasa Med Fac, Istanbul, Turkey -- [Karabay, O. -- Guclu, E.] Sakarya Univ, Fac Med, Sakarya, Turkey -- [Agalar, C. -- Alici, O.] Fatih Sultan Mehmet Educ & Res Hosp, Istanbul, Turkey -- [Akalin, S.] Pamukkale Univ, Fac Med, Denizli, Turkey -- [Alp, E. -- Kilic, A. U.] Erciyes Univ, Fac Med, Kayseri, Turkey -- [Altay, F. A.] Diskapi Educ & Res Hosp, Ankara, Turkey -- [Altin, N. -- Cesur, S.] Ankara Etlik Educ & Res Hosp, Ankara, Turkey -- [Arslan, F.] Istanbul Medipol Univ, Fac Med, Istanbul, Turkey -- [Aslan, T.] Bezmi Alem Univ, Fac Med, Istanbul, Turkey -- [Bekiroglu, N.] Marmara Univ, Fac Med, Istanbul, Turkey -- [Celik, A. D.] Trakya Univ, Fac Med, Edirne, Turkey -- [Dogan, M.] Namik Kemal Univ, Fac Med, Tekirdag, Turkey -- [Durdu, B.] Bakirkoy Sadi Konuk Educ & Res Hosp, Istanbul, Turkey -- [Duygu, F.] Gaziosmanpasa Univ, Fac Med, Tokat, Turkey -- [Engin, A.] Cumhuriyet Univ, Fac Med, Sivas, Turkey -- [Engin, D. O.] Haydarpasa Numune Educ & Res Hosp, Istanbul, Turkey -- [Gonen, I.] Suleyman Demirel Univ, Fac Med, TR-32200 Isparta, Turkey -- [Guven, T.] Ankara Ataturk Educ & Res Hosp, Ankara, Turkey -- [Hatipoglu, C. A.] Ankara Educ & Res Hosp, Ankara, Turkey -- [Hosoglu, S.] Dicle Univ, Fac Med, Diyarbakir, Turkey -- [Karahocagil, M. K.] Yuzuncu Yil Univ, Fac Med, Van, Turkey -- [Ormen, B.] Izmir Ataturk Educ & Res Hosp, Izmir, Turkey -- [Ozdemir, D. -- Sezak, N. -- Turker, N.] Duzce Univ, Educ & Res Hosp, Duzce, Turkey -- [Oztoprak, N.] Antalya Educ & Res Hosp, Antalya, Turkey -- [Turhan, V.] GATA Haydarpasa Educ & Res Hosp, Istanbul, Turkey -- [Yilmaz, H.] Ondokuz Mayis Univ, Fac Med, Samsun, Turkey | en_US |