Bahadır Ceylan1, Ferhat Arslan2, Oguz Resat Sipahi3, Mustafa Sunbul4, Bahar Ormen5, İsmail N Hakyemez6, Tuba Turunc7, Yeşim Yıldız8, Hasan Karsen9, Gul Karagoz10, Recep Tekin11, Burcu Hizarci12, Vedat Turhan13, Sebnem Senol14, Nefise Oztoprak15, Mesut Yılmaz1, Kevser Ozdemir16, Sinan Mermer3, Omer F Kokoglu17, Ali Mert1. 1. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medipol University, Turkey. 2. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe, Istanbul, Turkey. Electronic address: ferhatarslandr@hotmail.com. 3. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ege University, Izmir, Turkey. 4. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, 19 Mayıs University, Samsun, Turkey. 5. Department of Infectious Disease and Clinical Microbiology, Atatürk Education and Training Hospital, Izmir, Turkey. 6. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine,Vakıf Gureba Bezmi Alem University, Istanbul, Turkey. 7. Department of Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey. 8. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey. 9. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey. 10. Department of Infectious Diseases and Clinical Microbiology, Umraniye Education and Training Hospital, Istanbul, Turkey. 11. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey. 12. Department of Anesthesiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey. 13. Department of Infectious Diseases and Clinical Microbiology, Sultan Abdulhamid Education and Training Hospital, Istanbul, Turkey. 14. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey. 15. Department of Infectious Diseases and Clinical Microbiology, Antalya Education and Training Hospital, Antalya, Turkey. 16. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey. 17. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sutcu Imam University, Kahramanmaras, Turkey.
Abstract
AIM: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. MATERIALS AND METHODS: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. RESULTS: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. CONCLUSIONS: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.
AIM: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. MATERIALS AND METHODS: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. RESULTS: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. CONCLUSIONS: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.
Authors: Brian T Tsuji; Jason M Pogue; Alexandre P Zavascki; Mical Paul; George L Daikos; Alan Forrest; Daniele R Giacobbe; Claudio Viscoli; Helen Giamarellou; Ilias Karaiskos; Donald Kaye; Johan W Mouton; Vincent H Tam; Visanu Thamlikitkul; Richard G Wunderink; Jian Li; Roger L Nation; Keith S Kaye Journal: Pharmacotherapy Date: 2019-01 Impact factor: 6.251