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 RESEARCH ARTICLE
Year : 2015  |  Volume : 47  |  Issue : 1  |  Page : 95-100

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


1 Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
2 Kartal Dr. Lutfi Kirdar Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
3 Sakarya University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sakarya, Turkey
4 Fatih Sultan Mehmet Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
5 Pamukkale University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Denizli, Turkey
6 Erciyes University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Kayseri, Turkey
7 Diskapi Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
8 Ankara Etlik Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
9 Istanbul Medipol University, Medical Faculty, Infectious Diseases, Istanbul, Turkey
10 Bezmi Alem University, Medical Faculty, Infectious Diseases, Istanbul, Turkey
11 Marmara University, Medical Faculty, Biostatistics, Istanbul, Turkey
12 Trakya University, Medical Faculty, Infectious Diseases, Edirne, Turkey
13 Namik Kemal University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Tekirdag, Turkey
14 Bakirkoy Sadi Konuk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
15 Gaziosmanpasa University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Tokat, Turkey
16 Cumhuriyet University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Sivas, Turkey
17 Haydarpasa Numune Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
18 Suleyman Demirel University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Isparta, Turkey
19 Ankara Ataturk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
20 Ankara Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Ankara, Turkey
21 Dicle University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Diyarbakır, Turkey
22 Yuzuncu Yil University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Van, Turkey
23 Izmir Ataturk Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Izmir, Turkey
24 Duzce University, Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Düzce, Turkey
25 Antalya Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Antalya, Turkey
26 GATA Haydarpasa Education and Research Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
27 Ondokuz Mayıs University, Medical Faculty, Infectious Diseases and Clinical Microbiology, Samsun, Turkey

Correspondence Address:
Dr. Ilker Inanc Balkan
Istanbul University, Cerrahpasa Medical Faculty, Infectious Diseases and Clinical Microbiology, Istanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7613.150383

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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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