کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
5667056 | 1591749 | 2016 | 6 صفحه PDF | دانلود رایگان |

- Ventilator-associated pneumonia due to extensively drug-resistant Acinetobacter baumannii.
- Colistin combinations and colistin monotherapy had comparable mortality rates.
- When treating these infections, colistin monotherapy can be used; combinations should be avoided.
Limited data exist regarding prognostic factors and optimal antimicrobial treatment of infections caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB). This retrospective cohort study included 93 adult patients who developed ventilator-associated pneumonia (VAP) due to XDR-AB in the ICU of the University Hospital of Heraklion, Greece, from October 2012 to April 2015. XDR-AB isolates were mainly susceptible to colistin (93.5%) and tigecycline (25.8%), whereas 6 (6.5%) were pandrug-resistant. Prior to infection, patients had long durations of mechanical ventilation and hospital stay and multiple exposures to antibiotics. Median Charlson co-morbidity and APACHE II scores were 2 and 17, respectively. Mortality at 28 days of infection onset was high (34.4%) despite high rates of in-vitro-active empirical (81.7%) and definitive (90.3%) treatment. Active colistin-based combination therapy (nâ=â55) and monotherapy (nâ=â29) groups had similar 28-day mortality (27.6% vs. 30.9%, respectively) and Kaplan-Meier survival estimates over time. In multivariable Cox regression, advanced age (aHRâ=â1.05 per year increase, 95% CI 1.02-1.09), rapidly fatal underlying disease (aHRâ=â2.64, 95% CI 0.98-9.17) and APACHE II score (aHRâ=â1.06 per unit increase, 95% CI 0.99-1.14) were identified as independent predictors of 28-day mortality, but no difference in mortality hazards between the active colistin-based combination therapy and monotherapy groups was produced (aHRâ=â0.88, 95% CI 0.35-2.38). These results support the use of colistin as a first-line agent against VAP in settings where XDR-AB is endemic, but oppose the introduction of colistin-based combination therapy as standard treatment.
Journal: International Journal of Antimicrobial Agents - Volume 48, Issue 5, November 2016, Pages 492-497