Yael Zak-Doron1,2, Yael Dishon Benattar1,3, Iris Pfeffer4,5, George L Daikos6, Anna Skiada6, Anastasia Antoniadou7, Emanuele Durante-Mangoni8, Roberto Andini8, Giusi Cavezza8, Leonard Leibovici5,9, Dafna Yahav5,10, Noa Eliakim-Raz5,9, Yehuda Carmeli4,5, Amir Nutman4,5, Mical Paul1,2. 1. Institute of Infectious Diseases, Rambam Health Care Campus, Israel. 2. Faculty of Medicine, Technion, Israel Institute of Technology, Israel. 3. Cheryl Spencer Department of Nursing, University of Haifa, Israel. 4. Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Israel. 5. Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Aviv, Israel. 6. First Department of Medicine, Laiko General Hospital, Israel. 7. School of Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece. 8. Internal Medicine, University of Campania "L. Vanvitelli" and Azienda Ospedaliera di Rilievo Nazionale dei Colli-Monaldi Hospital, Napoli, Italy. 9. Department of Medicine E, Beilinson Hospital, Petah Tikva, Israel. 10. Unit of Infectious Diseases, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
Abstract
Background: Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods: This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching. Results: The study included 406 inpatients with severe CRGNB infections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02-1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score-matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91-2.22). Similar results were obtained in an analysis of 14-day mortality. Conclusions: Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.
RCT Entities:
Background: Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods: This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching. Results: The study included 406 inpatients with severe CRGNBinfections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02-1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score-matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91-2.22). Similar results were obtained in an analysis of 14-day mortality. Conclusions: Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.
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; Ki Ho Park; Shi Nae Yu; Seong Yeon Park; Se Yoon Park; Yu Mi Lee; Min Hyok Jeon; Eun Ju Choo; Tae Hyong Kim; Mi Suk Lee; EunJung Lee Journal: J Korean Med Sci Date: 2019-10-14 Impact factor: 2.153
Authors: Maddalena Giannella; Linda Bussini; Renato Pascale; Michele Bartoletti; Matteo Malagrinò; Livia Pancaldi; Alice Toschi; Giuseppe Ferraro; Lorenzo Marconi; Simone Ambretti; Russell Lewis; Pierluigi Viale Journal: Open Forum Infect Dis Date: 2019-12-12 Impact factor: 3.835