Impact of the initiation time of colistin treatment for Acinetobacter infections

Tigen, Elif Tükenmez; Koltka, Emine Nursen; Doğru, Arzu; Orhon, Zeynep Nur; Güra, Melek; Vahaboğlu, Haluk

doi:10.1007/s10156-013-0549-1

Cited by 14 publications

(17 citation statements)

References 26 publications

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“…However, findings are consistent with those of other studies [5,17,18], suggesting that they may be applicable to other populations.…”

Section: Discussionsupporting

confidence: 82%

“…Recent studies indicated that in most cases, colistinrelated nephrotoxicity is characteristically reversible [26][27][28], with the most consistent risk factor associated with nephrotoxicity being the colistin dose administered [29]. The current study indicates that treatment with intravenous colistin when used in a regimen of 2 million every eight hours decreases mortality, with results comparable to the mortality outcome of a higher dose of colistin (4.5 million units every eight hours) [18]. All renal injuries reported in the study were reversible, with no long-term renal dysfunction after the course of colistin therapy was completed.…”

Section: Discussionsupporting

confidence: 64%

“…Few studies have evaluated the impact of intravenous colistin on overall mortality when it is given as monotherapy to treat VAP caused by COS-AB [5,[17][18][19]. This study confirms that delaying colistin therapy increases mortality in these cases (Figure 1), and that a time delay of more than four days after the clinical diagnosis of VAP can result in a significant increase in mortality rate (63.3%) compared to cases with treatment delay of four or fewer days (26.9%) (p = 0.006).…”

Section: Discussionmentioning

confidence: 99%

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Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

Samrah

Bashtawi

Hayajneh

et al. 2016

J Infect Dev Ctries

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Introduction: There has been increased incidence and high mortality in cases with ventilator-associated pneumonia (VAP) caused by colistinonly-susceptible Acinetobacter baumannii (COS-AB). Colistin has emerged as a therapeutic option for VAP caused by multidrug-resistant Gram-negative organisms including COS-AB. A retrospective study was conducted to examine the impact of early versus late initiation of colistin on 30-day mortality of critically ill patients with VAP caused by COS-AB. Methodology: Critically ill patients with VAP caused by COS-AB who received colistin were enrolled. The receiver operating characteristic (ROC) curve was used to identify the temporal breakpoint that maximized the difference in 30-day mortality. Results: A total of 56 patients (34 men and 22 women) were included in the study. About 86% of all cases were late-onset VAP. The 30-day mortality was 46.4%. The rate was higher among patients with admission Acute Physiology and Chronic Health Evaluation II (APACHE II) score > 18 and patients with a delay of more than four days in initiating colistin treatment. The mortality rate was 26.9% among patients with treatment delay of four or fewer days and 63.3% for patients with a treatment delay of more than four days. Conclusions: A delay of four days or more in initiating colistin in patients with VAP caused by COS-AB significantly increases mortality. Colistin should be considered in the empirical protocols in late-onset VAP cases when COS-AB is highly suspected.

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“…However, findings are consistent with those of other studies [5,17,18], suggesting that they may be applicable to other populations.…”

Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

Samrah

Bashtawi

Hayajneh

et al. 2016

J Infect Dev Ctries

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“…Three prospective cohort studies, 20,24,31 32 retrospective cohort studies, [15][16][17][18][19][21][22][23][25][26][27][28][29][30]32,33,35,36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51] and two casecontrol studies 34,37 were included. Two studies were carried out internationally 16,44 and 35 in single countries across Europe, 22,24,31,34,38,43 Asia, 16,20,21,23,25,26,…”

Section: Description Of Studiesmentioning

confidence: 99%

A Systematic Review of the Effect of Delayed Appropriate Antibiotic Treatment on the Outcomes of Patients With Severe Bacterial Infections

Zasowski

Bassetti

Blasi

et al. 2020

Chest

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BACKGROUND: Patients with severe bacterial infections often experience delay in receiving appropriate treatment. Consolidated evidence of the impact of delayed appropriate treatment is needed to guide treatment and improve outcomes. RESEARCH QUESTION: What is the impact of delayed appropriate antibacterial therapy on clinical outcomes in patients with severe bacterial infections? STUDY DESIGN AND METHODS: Literature searches of MEDLINE and Embase, conducted on July 24, 2018, identified studies published after 2007 reporting the impact of delayed appropriate therapy on clinical outcomes for hospitalized adult patients with bacterial infections. Where appropriate, results were pooled and analyzed with delayed therapy modeled three ways: delay vs no delay in receiving appropriate therapy; duration of delay; and inappropriate vs appropriate initial therapy. This article reports meta-analyses on the effect of delay and duration of delay. RESULTS: The eligibility criteria were met by 145 studies, of which 37 contributed data to analyses of effect of delay. Mortality was significantly lower in patients receiving appropriate therapy without delay compared with those experiencing delay (OR, 0.57; 95% CI, 0.45-0.72). Mortality was also lower in the no-delay group compared with the delay group in subgroups of studies reporting mortality at 20 to 30 days, during ICU stay, or in patients with bacteremia (OR, 0.57 [95% CI, 0.43-0.76]; OR, 0.47 [95% CI, 0.27-0.80]; and OR, 0.54 [95% CI, 0.40-0.75], respectively). No difference was found in time to appropriate therapy between those who died and those who survived (P ¼ .09), but heterogeneity between studies was high. INTERPRETATION: Avoiding delayed appropriate therapy is essential to reduce mortality in patients with severe bacterial infections.

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“…Kan dolaşımı infeksiyonlarının tanısında kan kültürü altın standard yöntem olsa da, tanı için 24-72 saat arasında süre gerekmektedir. Bu nedenle tedavisi güç, morbidite ve mortalitesi yüksek ve erken tedavinin önemli olduğu Acinetobacter bakteriyemisinin, daha hızlı bakteri idantifikasyon yöntemle-riyle veya olası risk faktörleri saptanarak daha erken saptanması ve öngörülmesine ihtiyaç vardır (2,3).…”

Section: Introductionunclassified

Risk Factors for Bloodstream Infections Due to Acinetobacter spp.: A Prospective Case-Control Study

Uçar¹,

Kutlu²,

Kaleli³

2015

Klimik Dergisi

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Objective: The aim of this prospective case control study was to describe the risk factors for bacteremia due to Acinetobacter species among hospitalized patients. Methods: The study was conducted prospectively from July 2012 to January 2014, and one case group and two control groups were created. Case group comprising patients with Acinetobacter bacteremia and control group 1 comprising patients with bacteremia due to other agents and control group 2 comprising non-bacteremic patients were compared in terms of demographic characteristics, underlying diseases, invasive procedures, and antibiotic use. Results: The study group (n=23) and control groups (n=46) were compared with univariate analysis and significant risk factors for Acinetobacter bacteremia were as follows: total parenteral nutrition, chemotherapy, use of broad spectrum antibiotics including β-lactam and β-lactamase inhibitors, carbapenems, teicoplanin, and antifungals (p<0.05). The duration of hospitalization was longer in case group (p=0.005). In multivariate analysis, factors independently associated with an increased risk of Acinetobacter spp. bacteremia included total parenteral nutrition (odds ratio, OR 5.13; confidence interval 95%, CI 95%, 1. 41-18.57; p=0.013 ÖzetAmaç: Bu ileriye dönük olgu-kontrol çalışmasında Acinetobacter türleriyle gelişen bakteriyemiler için risk faktörlerinin belirlenmesi amaçlanmıştır. Yöntemler: Temmuz 2012-Ocak 2014 tarihleri arasında ileriye dönük olarak yürütülen çalışmada bir olgu ve iki kontrol grubu oluşturulmuştur. Olgu grubunda Acinetobacter bakteriyemisi olan hastalar yer almıştır. Kontrol grubu 1'e, kan kültüründe Acinetobacter dışı bakteri üremesi olan ve bakteriyemik olarak değerlendirilen hastalar; kontrol grubu 2'ye, kan kültüründe herhangi bir üremesi olmayan ve bakteriyemik olmadığı bilinen hastalar dahil edilmiştir. Bulgular: Tek değişkenli analizde olgu grubuyla (n=23) kontrol grupları (n=46) karşılaştırıldığında, olgu grubunda total parenteral besleme, kemoterapi alma oranı, β-laktam/β-laktamaz inhibitörü, karbapenem, teikoplanin ve antifungal kullanımı, kontrol gruplarına göre daha yüksek orandaydı ve anlamlı birer risk faktörü oldukları saptandı (p<0.05). Hastanede yatış süresi de olgu grubunda kontrol gruplarına göre daha uzun bulundu (p=0.005). Çok değişkenli analizde ise total parenteral besleme ("odds ratio", OR 5.13; %95 güven aralığı, %95 CI 1.41-18.57; p=0.013), β-laktam/β-laktamaz inhibitörü kullanımı (OR 7.67; %95 CI 1.67-35.25; p=0.009) ve teikoplanin kullanımı (OR 4.11; %95 CI 1.09-15.46; p=0.036), Acinetobacter spp. bakteriyemisi için bağımsız risk faktörleri olarak bulundu. Sonuçlar: Risk faktörleri saptanarak Acinetobacter bakteriyemisinin öngörülmesi, hasta yönetimi ve infeksiyon kontrol önlemle-ri yönünden daha erken müdahale etme olanağı verecektir.

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Impact of the initiation time of colistin treatment for Acinetobacter infections

Cited by 14 publications

References 26 publications

Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

Impact of colistin-initiation delay on mortality of ventilator-associated pneumonia caused by A. baumannii

A Systematic Review of the Effect of Delayed Appropriate Antibiotic Treatment on the Outcomes of Patients With Severe Bacterial Infections

Risk Factors for Bloodstream Infections Due to Acinetobacter spp.: A Prospective Case-Control Study

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