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      Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: A Multicenter retrospective analysis

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      , 1 , 2 , 3 , 4 , 3 , 5 , 6 , 7 , 8 , 9 , 10 , 7 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 2 , 18 , 19 , 20 , 21 , 5 , 22 , 23 , 1 , 24 , 23 , 25 , 23 , 26

      Indian Journal of Pharmacology

      Medknow Publications & Media Pvt Ltd

      Blood stream infection, colistin, monotherapy, multi drug resistant Acinetobacter spp.

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          Abstract

          Objectives:

          To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A).

          Materials and Methods:

          Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included.

          Primary End-Point:

          14-day mortality.

          Secondary End-Points:

          Microbial eradication and clinical improvement.

          Results:

          Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18–89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9–297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group ( P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group ( P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age ( P = 0.001), Charlson comorbidity index ( P = 0.03), duration of hospital stay before MDR-A BSI ( P = 0.04), Pitt bacteremia score ( P = 0.043) and Acute Physiology and Chronic Health Evaluation II score ( P = 0.05) were significant in terms of 14-day mortality. Advanced age ( P = 0.01) and duration of hospital stay before MDR-A BSI ( P = 0.04) were independently associated with 14-day mortality in multivariate analysis.

          Conclusion:

          No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

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          Most cited references 24

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          Colistin: the re-emerging antibiotic for multidrug-resistant Gram-negative bacterial infections.

          Increasing multidrug resistance in Gram-negative bacteria, in particular Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae, presents a critical problem. Limited therapeutic options have forced infectious disease clinicians and microbiologists to reappraise the clinical application of colistin, a polymyxin antibiotic discovered more than 50 years ago. We summarise recent progress in understanding the complex chemistry, pharmacokinetics, and pharmacodynamics of colistin, the interplay between these three aspects, and their effect on the clinical use of this important antibiotic. Recent clinical findings are reviewed, focusing on evaluation of efficacy, emerging resistance, potential toxicities, and combination therapy. In the battle against rapidly emerging bacterial resistance we can no longer rely entirely on the discovery of new antibiotics; we must also pursue rational approaches to the use of older antibiotics such as colistin.
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            Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies

            Introduction There has been a continuing controversy about whether infection with Acinetobacter baumannii increases morbidity and mortality independently of the effect of other confounding factors. Methods We performed a systematic review of matched case-control and cohort studies examining the mortality attributable to infection with or acquisition of A. baumannii (infection or colonization). We included in our review studies that compared mortality and/or morbidity of patients with acquisition of or infection with A. baumannii (cases) with the outcomes of matched patients without A. baumannii isolation from clinical specimens (controls). The relevant studies were identified from searches of the PubMed and the Cochrane Library databases. Two independent reviewers performed the literature search, study selection, and data extraction from nine identified relevant studies. Results The attributable mortalities, in the hospital and in the intensive care unit, of patients with A. baumannii infection in six matched case-control studies included in our review ranged from 7.8% to 23% and from 10% to 43%, respectively. In addition, a statistically significantly higher mortality was reported for patients with A. baumannii acquisition; that is, colonization or infection (cases) compared with controls without such an acquisition in all four reviewed studies that reported data on this comparison. Conclusion Although definitive statements about the mortality attributable to the acquisition of A. baumannii cannot be made from the available studies because of their methodological heterogeneity, the reviewed data suggest that infection with or acquisition of A. baumannii seems to be associated with increased mortality.
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              Outcome of infections due to pandrug-resistant (PDR) Gram-negative bacteria

              Background The increasing problem of infections due to multidrug-resistant Gram-negative bacteria has led to re-use of polymyxins in several countries. However, there are already clinical isolates of Gram-negative bacteria that are resistant to all available antibiotics, including polymyxins. Methods We present a case series of patients with infections due to pathogens resistant to all antimicrobial agents tested, including polymyxins. An isolate was defined as pandrug-resistant (PDR) if it exhibited resistance to all 7 anti-pseudomonal antimicrobial agents, i.e. antipseudomonal penicillins, cephalosporins, carbapenems, monobactams, quinolones, aminoglycosides, and polymyxins. Results Clinical cure of the infection due to pandrug-resistant (PDR) Gram-negative bacteria, namely Pseudomonas aeruginosa or Klebsiella pneumoniae was observed in 4 out of 6 patients with combination of colistin and beta lactam antibiotics. Conclusion Colistin, in combination with beta lactam antibiotics, may be a useful agent for the management of pandrug-resistant Gram-negative bacterial infections. The re-use of polymyxins, an old class of antibiotics, should be done with caution in an attempt to delay the rate of development of pandrug-resistant Gram-negative bacterial infections.
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                Author and article information

                Journal
                Indian J Pharmacol
                Indian J Pharmacol
                IJPharm
                Indian Journal of Pharmacology
                Medknow Publications & Media Pvt Ltd (India )
                0253-7613
                1998-3751
                Jan-Feb 2015
                : 47
                : 1
                : 95-100
                Affiliations
                Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
                [1 ]Kartal Dr. Lutfi Kirdar Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
                [2 ]Sakarya University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
                [3 ]Fatih Sultan Mehmet Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
                [4 ]Pamukkale University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Denizli, Turkey
                [5 ]Erciyes University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Kayseri, Turkey
                [6 ]Diskapi Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
                [7 ]Ankara Etlik Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
                [8 ]Istanbul Medipol University, Medical Faculty, Infectious Diseases, Istanbul, Turkey
                [9 ]Bezmi Alem University, Medical Faculty, Infectious Diseases, Istanbul, Turkey
                [10 ]Marmara University, Medical Faculty, Biostatistics, Istanbul, Turkey
                [11 ]Trakya University, Medical Faculty, Infectious Diseases, Edirne, Turkey
                [12 ]Namik Kemal University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Tekirdag, Turkey
                [13 ]Bakirkoy Sadi Konuk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
                [14 ]Gaziosmanpasa University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Tokat, Turkey
                [15 ]Cumhuriyet University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sivas, Turkey
                [16 ]Haydarpasa Numune Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
                [17 ]Suleyman Demirel University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Isparta, Turkey
                [18 ]Ankara Ataturk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
                [19 ]Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
                [20 ]Dicle University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
                [21 ]Yuzuncu Yil University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Van, Turkey
                [22 ]Izmir Ataturk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Izmir, Turkey
                [23 ]Duzce University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Düzce, Turkey
                [24 ]Antalya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Antalya, Turkey
                [25 ]GATA Haydarpasa Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
                [26 ]Ondokuz Mayıs University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Samsun, Turkey
                Author notes
                Correspondence to: Dr. Ilker Inanc Balkan, E-mail: ilkerinancbalkan@ 123456hotmail.com
                Article
                IJPharm-47-95
                10.4103/0253-7613.150383
                4375827
                Copyright: © Indian Journal of Pharmacology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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