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Short versus long course of colistin treatment for carbapenem-resistant A. baumannii in critically ill patients: A propensity score matching study
Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly found nosocomial infections in critically ill patients. However, the appropriate treatment period for a specific group of critically ill patients with CRAB infection is currently being debated. Therefore, our study aimed...
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| Published in: | Journal of infection and public health 2023-08, Vol.16 (8), p.1249-1255 |
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| creator | Katip, Wasan Rayanakorn, Ajaree Oberdorfer, Peninnah Taruangsri, Puntapong Nampuan, Teerapong |
| description | Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly found nosocomial infections in critically ill patients. However, the appropriate treatment period for a specific group of critically ill patients with CRAB infection is currently being debated. Therefore, our study aimed to evaluate the optimal courses of therapy for critically ill patients with CRAB infection by comparing the outcomes of colistin therapy of short duration ( |
| doi_str_mv | 10.1016/j.jiph.2023.05.024 |
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A retrospective cohort study was conducted at Nakornping Hospital on critically ill patients with CRAB infection who received either a short or long course of colistin treatment between 2015 and 2022. The primary outcome was the 30-day mortality rate while secondary outcomes were clinical response, microbiological response, and nephrotoxicity. Propensity score matching with a 1: 1 ratio was performed to reduce potential biases. Furthermore, a logistic regression model was used to estimate the odds ratio (OR).
A total of 374 patients met the inclusion criteria. Two hundred and forty-eight patients were recruited after utilizing propensity scores to match patients at a 1: 1 ratio. The results from the propensity score matching analysis demonstrated that the long-course therapy group had a lower 30-day mortality rate compared to the short-course therapy group (adjusted OR (aOR) = 0.46, 95% CI: 0.26–0.83, p = 0.009). The clinical response and microbiological response rates were higher in patients who received the long course of colistin therapy compared to those receiving the short course (aOR = 3.24, 95% CI: 1.78–5.92, p = 0.001; aOR = 3.01, 95% CI: 1.63–5.57, p = 0.001). There was no significant different in the occurrence of nephrotoxicity (aOR = 1.28, 95% CI: 0.74–2.22, p = 0.368) between the two treatment groups.
A long course of colistin therapy resulted in a lower 30-day mortality rate in critically ill patients, and better clinical and microbiological outcomes, but similar nephrotoxicity as compared to a short course of colistin therapy. Therefore, a specific subset of critically ill patients who had CRAB infection needed to be considered for a long course of therapy.</description><identifier>ISSN: 1876-0341</identifier><identifier>EISSN: 1876-035X</identifier><identifier>DOI: 10.1016/j.jiph.2023.05.024</identifier><identifier>PMID: 37295057</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Acinetobacter baumannii - physiology ; Acinetobacter Infections - microbiology ; Anti-Bacterial Agents ; Carbapenems - therapeutic use ; Colistin ; Colistin - therapeutic use ; CRAB infection ; Critical Illness ; Critically ill patients ; Duration of treatment ; Humans ; Propensity Score ; Propensity score analysis ; Retrospective Studies</subject><ispartof>Journal of infection and public health, 2023-08, Vol.16 (8), p.1249-1255</ispartof><rights>2023 The Author(s)</rights><rights>Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c466t-875f2ada77d3ba0af8760d9fd9016b0dbf0314fd0b9340938eac9fc7fff3feae3</citedby><cites>FETCH-LOGICAL-c466t-875f2ada77d3ba0af8760d9fd9016b0dbf0314fd0b9340938eac9fc7fff3feae3</cites><orcidid>0000-0002-5961-8978 ; 0000-0001-7665-8819</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S187603412300179X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3536,27901,27902,45756</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37295057$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Katip, Wasan</creatorcontrib><creatorcontrib>Rayanakorn, Ajaree</creatorcontrib><creatorcontrib>Oberdorfer, Peninnah</creatorcontrib><creatorcontrib>Taruangsri, Puntapong</creatorcontrib><creatorcontrib>Nampuan, Teerapong</creatorcontrib><title>Short versus long course of colistin treatment for carbapenem-resistant A. baumannii in critically ill patients: A propensity score matching study</title><title>Journal of infection and public health</title><addtitle>J Infect Public Health</addtitle><description>Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly found nosocomial infections in critically ill patients. However, the appropriate treatment period for a specific group of critically ill patients with CRAB infection is currently being debated. Therefore, our study aimed to evaluate the optimal courses of therapy for critically ill patients with CRAB infection by comparing the outcomes of colistin therapy of short duration (<14 days) versus long duration (≥ 14 days).
A retrospective cohort study was conducted at Nakornping Hospital on critically ill patients with CRAB infection who received either a short or long course of colistin treatment between 2015 and 2022. The primary outcome was the 30-day mortality rate while secondary outcomes were clinical response, microbiological response, and nephrotoxicity. Propensity score matching with a 1: 1 ratio was performed to reduce potential biases. Furthermore, a logistic regression model was used to estimate the odds ratio (OR).
A total of 374 patients met the inclusion criteria. Two hundred and forty-eight patients were recruited after utilizing propensity scores to match patients at a 1: 1 ratio. The results from the propensity score matching analysis demonstrated that the long-course therapy group had a lower 30-day mortality rate compared to the short-course therapy group (adjusted OR (aOR) = 0.46, 95% CI: 0.26–0.83, p = 0.009). The clinical response and microbiological response rates were higher in patients who received the long course of colistin therapy compared to those receiving the short course (aOR = 3.24, 95% CI: 1.78–5.92, p = 0.001; aOR = 3.01, 95% CI: 1.63–5.57, p = 0.001). There was no significant different in the occurrence of nephrotoxicity (aOR = 1.28, 95% CI: 0.74–2.22, p = 0.368) between the two treatment groups.
A long course of colistin therapy resulted in a lower 30-day mortality rate in critically ill patients, and better clinical and microbiological outcomes, but similar nephrotoxicity as compared to a short course of colistin therapy. Therefore, a specific subset of critically ill patients who had CRAB infection needed to be considered for a long course of therapy.</description><subject>Acinetobacter baumannii - physiology</subject><subject>Acinetobacter Infections - microbiology</subject><subject>Anti-Bacterial Agents</subject><subject>Carbapenems - therapeutic use</subject><subject>Colistin</subject><subject>Colistin - therapeutic use</subject><subject>CRAB infection</subject><subject>Critical Illness</subject><subject>Critically ill patients</subject><subject>Duration of treatment</subject><subject>Humans</subject><subject>Propensity Score</subject><subject>Propensity score analysis</subject><subject>Retrospective Studies</subject><issn>1876-0341</issn><issn>1876-035X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNp9UcuO1DAQjBCIfcAPcEA-cknwIy8jLqMVLCutxAGQuFkdu73jKImD7aw0v8EX42GWOXJyy11VraoqijeMVoyy9v1YjW7dV5xyUdGmorx-VlyyvmtLKpqfz89zzS6KqxhHSlvR1PJlcSE6LhvadJfF7297HxJ5xBC3SCa_PBDttxCReJunycXkFpICQppxScT6QDSEAVZccC4DxoyAvNhVZIBthmVxjmSKDi45DdN0IG6ayArJZX78QHZkDT6zo0sHErUPSGZIeu_y6Zg2c3hVvLAwRXz99F4XPz5_-n7zpbz_ent3s7svdd22qey7xnIw0HVGDEDBZrPUSGtkzmagZrBUsNoaOkhRUyl6BC2t7qy1wiKguC7uTrrGw6jW4GYIB-XBqb8fPjwoCNnDhAoNGxjvGypbWSMHaLnuOQietZhmNmu9O2llb782jEnNLmqcJljQb1Hxntet5Ex2GcpPUB18jAHt-TSj6tirGtWxV3XsVdFG5V4z6e2T_jbMaM6Uf0VmwMcTAHNijw6DijoHrtG4gDplS-5_-n8ANYS4Tw</recordid><startdate>202308</startdate><enddate>202308</enddate><creator>Katip, Wasan</creator><creator>Rayanakorn, Ajaree</creator><creator>Oberdorfer, Peninnah</creator><creator>Taruangsri, Puntapong</creator><creator>Nampuan, Teerapong</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-5961-8978</orcidid><orcidid>https://orcid.org/0000-0001-7665-8819</orcidid></search><sort><creationdate>202308</creationdate><title>Short versus long course of colistin treatment for carbapenem-resistant A. baumannii in critically ill patients: A propensity score matching study</title><author>Katip, Wasan ; Rayanakorn, Ajaree ; Oberdorfer, Peninnah ; Taruangsri, Puntapong ; Nampuan, Teerapong</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c466t-875f2ada77d3ba0af8760d9fd9016b0dbf0314fd0b9340938eac9fc7fff3feae3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Acinetobacter baumannii - physiology</topic><topic>Acinetobacter Infections - microbiology</topic><topic>Anti-Bacterial Agents</topic><topic>Carbapenems - therapeutic use</topic><topic>Colistin</topic><topic>Colistin - therapeutic use</topic><topic>CRAB infection</topic><topic>Critical Illness</topic><topic>Critically ill patients</topic><topic>Duration of treatment</topic><topic>Humans</topic><topic>Propensity Score</topic><topic>Propensity score analysis</topic><topic>Retrospective Studies</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Katip, Wasan</creatorcontrib><creatorcontrib>Rayanakorn, Ajaree</creatorcontrib><creatorcontrib>Oberdorfer, Peninnah</creatorcontrib><creatorcontrib>Taruangsri, Puntapong</creatorcontrib><creatorcontrib>Nampuan, Teerapong</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Journal of infection and public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Katip, Wasan</au><au>Rayanakorn, Ajaree</au><au>Oberdorfer, Peninnah</au><au>Taruangsri, Puntapong</au><au>Nampuan, Teerapong</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Short versus long course of colistin treatment for carbapenem-resistant A. baumannii in critically ill patients: A propensity score matching study</atitle><jtitle>Journal of infection and public health</jtitle><addtitle>J Infect Public Health</addtitle><date>2023-08</date><risdate>2023</risdate><volume>16</volume><issue>8</issue><spage>1249</spage><epage>1255</epage><pages>1249-1255</pages><issn>1876-0341</issn><eissn>1876-035X</eissn><abstract>Carbapenem-resistant Acinetobacter baumannii (CRAB) is one of the most commonly found nosocomial infections in critically ill patients. However, the appropriate treatment period for a specific group of critically ill patients with CRAB infection is currently being debated. Therefore, our study aimed to evaluate the optimal courses of therapy for critically ill patients with CRAB infection by comparing the outcomes of colistin therapy of short duration (<14 days) versus long duration (≥ 14 days).
A retrospective cohort study was conducted at Nakornping Hospital on critically ill patients with CRAB infection who received either a short or long course of colistin treatment between 2015 and 2022. The primary outcome was the 30-day mortality rate while secondary outcomes were clinical response, microbiological response, and nephrotoxicity. Propensity score matching with a 1: 1 ratio was performed to reduce potential biases. Furthermore, a logistic regression model was used to estimate the odds ratio (OR).
A total of 374 patients met the inclusion criteria. Two hundred and forty-eight patients were recruited after utilizing propensity scores to match patients at a 1: 1 ratio. The results from the propensity score matching analysis demonstrated that the long-course therapy group had a lower 30-day mortality rate compared to the short-course therapy group (adjusted OR (aOR) = 0.46, 95% CI: 0.26–0.83, p = 0.009). The clinical response and microbiological response rates were higher in patients who received the long course of colistin therapy compared to those receiving the short course (aOR = 3.24, 95% CI: 1.78–5.92, p = 0.001; aOR = 3.01, 95% CI: 1.63–5.57, p = 0.001). There was no significant different in the occurrence of nephrotoxicity (aOR = 1.28, 95% CI: 0.74–2.22, p = 0.368) between the two treatment groups.
A long course of colistin therapy resulted in a lower 30-day mortality rate in critically ill patients, and better clinical and microbiological outcomes, but similar nephrotoxicity as compared to a short course of colistin therapy. Therefore, a specific subset of critically ill patients who had CRAB infection needed to be considered for a long course of therapy.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>37295057</pmid><doi>10.1016/j.jiph.2023.05.024</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-5961-8978</orcidid><orcidid>https://orcid.org/0000-0001-7665-8819</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of infection and public health, 2023-08, Vol.16 (8), p.1249-1255 |
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| source | ScienceDirect (Online service) |
| subjects | Acinetobacter baumannii - physiology Acinetobacter Infections - microbiology Anti-Bacterial Agents Carbapenems - therapeutic use Colistin Colistin - therapeutic use CRAB infection Critical Illness Critically ill patients Duration of treatment Humans Propensity Score Propensity score analysis Retrospective Studies |
| title | Short versus long course of colistin treatment for carbapenem-resistant A. baumannii in critically ill patients: A propensity score matching study |
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