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

• Published in: Indian journal of pharmacology 2015-01, Vol.47 (1), p.95-100
• Main Authors: Balkan, Ilker Inanc, Batirel, Ayse, Karabay, Oguz, Agalar, Canan, Akalin, Serife, Alici, Ozlem, Alp, Emine, Altay, Fatma Aybala, Altin, Nilgun, Arslan, Ferhat, Aslan, Turan, Bekiroglu, Nural, Cesur, Salih, Celik, Aygul Dogan, Dogan, Mustafa, Durdu, Bulent, Duygu, Fazilet, Engin, Aynur, Engin, Derya Ozturk, Gonen, Ibak, Guclu, Ertugrul, Guven, Tumer, Hatipoglu, Cigdem Ataman, Hosoglu, Salih, Karahocagil, Mustafa Kasim, Kilic, Aysegul Ulu, Ormen, Bahar, Ozdemir, Davut, Ozer, Serdar, Oztoprak, Nefise, Sezak, Nurbanu, Turhan, Vedat, Turker, Nesrin, Yilmaz, Hava
• Format: Article
• Language: English
• Subjects: Acinetobacter; Acinetobacter - drug effects; Acinetobacter - pathogenicity; Acinetobacter Infections - drug therapy; Acinetobacter Infections - microbiology; Acinetobacter Infections - mortality; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; APACHE; Bacteremia - drug therapy; Bacteremia - microbiology; Bacteremia - mortality; Bacterial infections; Blood; Chi-Square Distribution; Colistin - adverse effects; Colistin - therapeutic use; Combination drug therapy; Comorbidity; Comparative analysis; Comparative studies; Drug resistance; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Health aspects; Host-parasite relationships; Humans; Kaplan-Meier Estimate; Length of Stay; Male; Middle Aged; Multivariate Analysis; Pharmacology; Prevention; Proportional Hazards Models; Remission Induction; Retrospective Studies; Risk Factors; Tertiary Care Centers; Time Factors; Treatment Outcome; Turkey; Young Adult
• ISSN: 0253-7613; 1998-3751
• DOI: 10.4103/0253-7613.150383

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). Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. 14-day mortality. Microbial eradication and clinical improvement. 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. 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.