T Amat1, A Gutiérrez-Pizarraya2, I Machuca3, I Gracia-Ahufinger3, E Pérez-Nadales3, Á Torre-Giménez4, J Garnacho-Montero5, J M Cisneros2, J Torre-Cisneros3. 1. Hospital Universitario Reina Sofía-IMIBIC-University of Córdoba, (Spanish Network for Research in Infectious Diseases (REIPI)), Córdoba, Spain. Electronic address: tanquov85@gmail.com. 2. Hospitales Universitarios Virgen del Rocío-IBIS, (REIPI), Seville, Spain. 3. Hospital Universitario Reina Sofía-IMIBIC-University of Córdoba, (Spanish Network for Research in Infectious Diseases (REIPI)), Córdoba, Spain. 4. Complejo Hospitalario de Jaén, Jaén, Spain. 5. Hospital Universitario Virgen Macarena-IBIS, (REIPI), Seville, Spain.
Abstract
OBJECTIVE: To assess the association of survival and treatment with colistin and tigecycline in critically ill patients with carbapenem-resistant Acinetobacter baumannii bacteraemia. METHODS: An observational cohort study was carried out. Targeted therapy consisted of monotherapy with colistin (9 million UI/day) or combined therapy with colistin and tigecycline (100 g/day). The primary outcome was 30-day crude mortality. The association between combined targeted therapy and mortality was controlled for empirical therapy with colistin, propensity score of combined therapy and other potential confounding variables in a multivariate Cox regression analysis. RESULTS: A total of 118 cases were analysed. Seventy-six patients (64%) received monotherapy and 42 patients (36%) received combined therapy. The source of bacteraemia was primary in 18% (21/118) of the patients, ventilator-associated pneumonia in 64% (76/118) and other sources in 14% (16/118). The 30-day crude mortality rate was 62% (42/76) for monotherapy and 57% (24/42) for combined therapy. The variables associated with 30-day crude mortality were: Charlson index (hazard ratio (HR) 1.16, 95% CI 1.02-1.32; p 0.028), empirical therapy with colistin (HR 2.25, 95% CI 1.33-3.80; p 0.003) and renal dysfunction before treatment (HR 1.91, 95% CI 1.01-3.61; p 0.045). Combined targeted therapy was not associated with lower adjusted 30-day crude mortality (adjusted HR 1.29, 95% CI 0.64-2.58; p 0.494). CONCLUSIONS: Combined targeted therapy with high-dose colistin and standard dose tigecycline was not associated with lower crude mortality of bacteraemia due to carbapenem-resistant A. baumannii in critically ill patients. TRIAL REGISTRATION: Registered in ClinicalTrials.gov. Identifier: NCT02573064.
OBJECTIVE: To assess the association of survival and treatment with colistin and tigecycline in critically illpatients with carbapenem-resistant Acinetobacter baumanniibacteraemia. METHODS: An observational cohort study was carried out. Targeted therapy consisted of monotherapy with colistin (9 million UI/day) or combined therapy with colistin and tigecycline (100 g/day). The primary outcome was 30-day crude mortality. The association between combined targeted therapy and mortality was controlled for empirical therapy with colistin, propensity score of combined therapy and other potential confounding variables in a multivariate Cox regression analysis. RESULTS: A total of 118 cases were analysed. Seventy-six patients (64%) received monotherapy and 42 patients (36%) received combined therapy. The source of bacteraemia was primary in 18% (21/118) of the patients, ventilator-associated pneumonia in 64% (76/118) and other sources in 14% (16/118). The 30-day crude mortality rate was 62% (42/76) for monotherapy and 57% (24/42) for combined therapy. The variables associated with 30-day crude mortality were: Charlson index (hazard ratio (HR) 1.16, 95% CI 1.02-1.32; p 0.028), empirical therapy with colistin (HR 2.25, 95% CI 1.33-3.80; p 0.003) and renal dysfunction before treatment (HR 1.91, 95% CI 1.01-3.61; p 0.045). Combined targeted therapy was not associated with lower adjusted 30-day crude mortality (adjusted HR 1.29, 95% CI 0.64-2.58; p 0.494). CONCLUSIONS: Combined targeted therapy with high-dose colistin and standard dose tigecycline was not associated with lower crude mortality of bacteraemia due to carbapenem-resistant A. baumannii in critically illpatients. TRIAL REGISTRATION: Registered in ClinicalTrials.gov. Identifier: NCT02573064.
Authors: David A Butler; Mark Biagi; Xing Tan; Samah Qasmieh; Zackery P Bulman; Eric Wenzler Journal: Curr Infect Dis Rep Date: 2019-11-16 Impact factor: 3.725
Authors: Tark Kim; Eun Jung Lee; Seong Yeon Park; Shi Nae Yu; Yu Mi Lee; Ki-Ho Park; Se Yoon Park; Min Hyok Jeon; Eun Ju Choo; Tae Hyong Kim; Mi Suk Lee Journal: Medicine (Baltimore) Date: 2018-10 Impact factor: 1.817
Authors: Zaaima Al-Jabri; Roxana Zamudio; Eva Horvath-Papp; Joseph D Ralph; Zakariya Al-Muharrami; Kumar Rajakumar; Marco R Oggioni Journal: Genes (Basel) Date: 2018-07-20 Impact factor: 4.096