scholarly journals 523. Dual vs. Triple Antibiotic Therapy for Carbapenem-Resistant Acinetobacter baumannii Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S252-S252
Author(s):  
Justin Patrick Markelwith ◽  
Nikunj M Vyas ◽  
Mark Condoluci ◽  
Sungwook Kim
Keyword(s):  
Combination Therapy ◽  
Serum Creatinine ◽  
Antibiotic Therapy ◽  
Acinetobacter Baumannii ◽  
Clinical Cure ◽  
Group Analysis ◽  
Elevated Serum ◽  
Positive Association ◽  
Primary Analysis ◽  
Carbapenem Resistant

Abstract Background Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) remain some of the most difficult to treat due to extremely high rates of resistance. The purpose of this study was to compare the efficacy of dual vs. triple targeted antibiotic regimens for CRAB infections. Methods This was an IRB approved retrospective cohort study performed at a 607-bed community health system between January 2016 and December 2018. Patients were included in the analysis if they were ≥18 years old and received antibiotics for CRAB for ≥72 hours. Patients were excluded if they were pregnant and had CRAB isolated solely from the urine. The primary endpoints of the study were differences in all-cause in-hospital mortality (ACIM) and clinical cure (CC) rates for patients treated with dual vs. triple antibiotic therapy. The secondary endpoint result focused on the difference in length of stay (LOS) between treatment groups. A sub-group analysis was performed for patients treated with tigecycline vs. minocycline combination therapy to determine differences ACIM and CC, and LOS. A multi-logistic regression analysis (MLRA) was performed to determine patient factors that were associated with ACIM and CC. Results A total of 32 patients were included in the primary analysis. No difference was seen in ACIM between dual vs. triple antibiotic groups (9.5% vs. 18.2%, P = 0.59). CC (63.6% vs. 57.1%, P = 1.0) and LOS (12 vs. 11 days, P = 1.0) was similar amongst patients treated with dual vs. triple antibiotic group. No differences were seen in ACIM (15.4% vs. 16.7% P = 1.0), CC (83.3% vs. 69.2%, P = 1.0) and LOS (15 vs. 14 days, P = 1.0) between tigecycline and minocycline combination therapy groups. The MLRA revealed a positive association with increased serum creatinine and ACIM (OR 3.29, 95% CI 1.35–8.04; P = 0.009) as well as shorter time to appropriate antibiotic therapy and clinical cure (OR 1.49, 95% CI 1.02–2.20; P = 0.04). CRAB isolates were more likely to be susceptible to minocycline vs. tigecycline (83% vs. 18%, P = 0.003). Conclusion No differences were seen in ACIM, CC and LOS between dual vs. triple antibiotic groups. Minocycline tends to sustain better susceptibility toward CRAB vs. tigecycline. Elevated serum creatinine was found to be a predictor for ACIM while shorter time to appropriate antibiotic therapy was associated with CC. Disclosures All authors: No reported disclosures.

scholarly journals 135. Clinical and Microbiologic Analysis of Risk Factors for Mortality in Patients with Carbapenem-Resistant Acinetobacter baumannii Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S95-S96
Author(s):  
Eunbeen Cho ◽  
Hyo-Ju Son ◽  
Seongman Bae ◽  
Hyeonji Seo ◽  
Eunmi Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tract Infection ◽  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Biliary Tract ◽  
Microbiological Analysis ◽  
Biliary Tract Infection ◽  
Clinical Issue ◽  
Catheter Related Infection ◽  
Carbapenem Resistant

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is an emerging clinical issue and shows high mortality rates. There are a few studies that have evaluated the microbiologic risk factors for mortality in CRAB bacteremia. Aim of this study is to identify the clinical and microbiologic risk factors for mortality in CRAB bacteremia. Methods Adult patients with monomicrobial CRAB bacteremia at a 2,700-bed tertiary hospital between December 2012 and December 2018 were retrospectively enrolled in the study. Risk factors for 30-day mortality were evaluated through a detailed clinical and microbiological analysis of study patients. All isolates collected on the first day of bacteremia were subjected to colistin susceptibility testing by broth microdilution and genotyping by multilocus sequence typing (MLST). Results A total of 164 patients were enrolled and 90 (55%) died within 30 days. Of the 164 patients, 111 (68%) were male and median age was 66.5 years. The most common MLST genotype was ST191 (80 isolates, 49%), followed by ST451 (14%) and ST784 (13%), and 12 (7%) isolates were resistant to colistin (MIC ≥4 mg/L). Deceased patients were more likely to have hematologic malignancy, neutropenia, pneumonia, and primary bacteremia; less likely to have solid tumor, catheter-related infection, and biliary tract infection; more likely to have a high Pitt bacteremia score; and less likely to receive appropriate antibiotic treatment, colistin, and combination therapy with colistin and tigecycline, compared with surviving patients (Table 1). Genotype, colistin MIC, and colistin resistance were not associated with mortality (Figure 1 and 2). In multivariable analysis, neutropenia (aOR, 3.25; 95% CI, 1.18–8.95), catheter-related infection (aOR, 0.33; 95% CI, 0.11–0.99), biliary tract infection (aOR, 0.20; 95% CI, 0.04–0.99), a high Pitt bacteremia score (aOR,1.42; 95% CI, 1.20–1.67), and combination therapy with colistin and tigecycline (aOR, 0.36; 95% CI, 0.14–0.92) were independent risk factors for mortality (Table 2). Conclusion Clinical factors such as the site of infection, severity of bacteremia, and specific combination therapy rather than microbiologic factors contributed to mortality in CRAB bacteremia. Appropriate combination therapy may help improving outcomes in CRAB bacteremia. Disclosures All authors: No reported disclosures.

scholarly journals Melatonin synergistically enhances protective effect of atorvastatin against gentamicin-induced nephrotoxicity in rat kidney

2016 ◽  
Vol 94 (3) ◽  
pp. 265-271 ◽  
Author(s):  
Saeed Mehrzadi ◽  
Seyed Kamran Kamrava ◽  
Banafshe Dormanesh ◽  
Manijeh Motevalian ◽  
Azam Hosseinzadeh ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Combination Therapy ◽  
Serum Creatinine ◽  
Rat Kidney ◽  
Elevated Serum ◽  
Albino Rats ◽  
Kidney Weight ◽  
Sod Activity ◽  
Creatinine Concentration ◽  
Beneficial Effects

The risk of serious side-effects such as nephrotoxicity is the principal limitation of gentamicin (GEN) therapeutic efficacy. Oxidative stress is considered to be an important mediator of GEN-induced nephrotoxicity. The present study was designed to evaluate the efficacy of the combination of melatonin (MT) plus atorvastatin (ATO) against GEN-induced nephrotoxicity in rats. We utilized 30 male Wistar albino rats allocated in 5 groups, each containing 6 rats: control, GEN (100 mg/kg/day), ATO (10 mg/kg/day) + GEN, MT (20 mg/kg/day) + GEN, and ATO (10 mg/kg/day) plus MT (20 mg/kg/day) + GEN. Kidney weight, serum creatinine and urea concentration, renal ROS, MDA, GSH levels, SOD, and CAT activity were determined. GEN-induced nephrotoxicity was evidenced by marked elevations in serum urea and creatinine, kidney weight, renal ROS, and MDA levels and reduction in renal GSH level, SOD and CAT activity. MT pretreatment significantly lowered the elevated serum creatinine concentration, kidney weight, renal ROS and MDA levels. However ATO could not reduce these parameters, but similarly to MT, it was able to enhance the renal GSH level, CAT and SOD activity. In addition, a combination therapy of MT plus ATO enhanced the beneficial effects of ATO, while not changing the effects of MT effects or even improving them. The present study indicates that a combination therapy of MT plus ATO can attenuate renal injury in rats treated with GEN, possibly by reducing oxidative stress, and it seems that MT can enhance the beneficial effects of ATO.

Outcomes in patients infected with carbapenem-resistant Acinetobacter baumannii and treated with tigecycline alone or in combination therapy

Infection ◽  
2011 ◽  
Vol 39 (6) ◽  
pp. 515-518 ◽  
Author(s):  
R. Guner ◽  
I. Hasanoglu ◽  
S. Keske ◽  
A. K. Kalem ◽  
M. A. Tasyaran
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Carbapenem Resistant

scholarly journals Preliminary Study of Colistin versus Colistin plus Fosfomycin for Treatment of Carbapenem-Resistant Acinetobacter baumannii Infections

2014 ◽  
Vol 58 (9) ◽  
pp. 5598-5601 ◽  
Author(s):  
Rujipas Sirijatuphat ◽  
Visanu Thamlikitkul
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Clinical Outcomes ◽  
Lower Mortality ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Preliminary Study ◽  
To Receive

ABSTRACTNinety-four patients infected with carbapenem-resistantAcinetobacter baumanniiwere randomized to receive colistin alone or colistin plus fosfomycin for 7 to 14 days. The patients who received combination therapy had a significantly more favorable microbiological response and a trend toward more favorable clinical outcomes and lower mortality than those who received colistin alone. (This study has been registered at ClinicalTrials.gov under registration no. NCT01297894.)

scholarly journals Growing OXA-23 type strains among carbapenem-resistant Acinetobacter baumannii and tigecycline as an alternate combination therapy

2016 ◽  
Vol 46 ◽  
pp. 1894-1899 ◽  
Author(s):  
Şerife ALTUN ◽  
Zeliha KOÇAK TUFAN ◽  
Belgin ALTUN ◽  
Ufuk ÖNDE ◽  
Sami KINIKLI ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Carbapenem Resistant ◽  
Type Strains

Do Results of Surveillance Cultures Impact the Choice of Empirical Antibiotics Among Patients with Carbapenem-Resistant Acinetobacter baumannii Infections?

2015 ◽  
Vol 36 (12) ◽  
pp. 1455-1457
Author(s):  
Rossana Rosa ◽  
Jose Castro ◽  
Rachel Latibeaudiere ◽  
Nicholas Namias ◽  
L. Silvia Munoz-Price
Keyword(s):  
Antibiotic Therapy ◽  
Acinetobacter Baumannii ◽  
Infect Control Hosp ◽  
Empirical Antibiotic Therapy ◽  
Carbapenem Resistant ◽  
Surveillance Cultures ◽  
Empirical Antibiotics

We aimed to determine whether the results of surveillance cultures were associated with use of appropriate empirical antibiotic therapy among patients with carbapenem-resistant Acinetobacter baumannii infections. We found that surveillance status was not associated with appropriate empirical antibiotic therapy (P=.36). There were significant delays to concordant therapy among surveillance-positive patients (P=.03).Infect. Control Hosp. Epidemiol. 2015;36(12):1455–1457

Colistin Resistance Development Following Colistin-Meropenem Combination Therapy Versus Colistin Monotherapy in Patients With Infections Caused by Carbapenem-Resistant Organisms

2019 ◽  
Vol 71 (10) ◽  
pp. 2599-2607 ◽  
Author(s):  
Yaakov Dickstein ◽  
Jonathan Lellouche ◽  
David Schwartz ◽  
Amir Nutman ◽  
Nadya Rakovitsky ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Controlled Trial ◽  
Secondary Outcome ◽  
Colistin Resistance ◽  
Primary Analysis ◽  
Resistance Development ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Severe Infections ◽  
Gram Negative Organisms

Abstract Background We evaluated whether carbapenem-colistin combination therapy reduces the emergence of colistin resistance, compared to colistin monotherapy, when given to patients with infections due to carbapenem-resistant Gram-negative organisms. Methods This is a pre-planned analysis of a secondary outcome from a randomized, controlled trial comparing colistin monotherapy with colistin-meropenem combination for the treatment of severe infections caused by carbapenem-resistant, colistin-susceptible Gram-negative bacteria. We evaluated rectal swabs taken on Day 7 or later for the presence of new colistin-resistant (ColR) isolates. We evaluated the emergence of any ColR isolate and the emergence of ColR Enterobacteriaceae (ColR-E). Results Data were available for 214 patients for the primary analysis; emergent ColR organisms were detected in 22 (10.3%). No difference was observed between patients randomized to treatment with colistin monotherapy (10/106, 9.4%) versus patients randomized to colistin-meropenem combination therapy (12/108, 11.1%; P = .669). ColR-E organisms were detected in 18/249 (7.2%) patients available for analysis. No difference was observed between the 2 treatment arms (colistin monotherapy 6/128 [4.7%] vs combination therapy 12/121 [9.9%]; P = .111). Enterobacteriaceae, as the index isolate, was found to be associated with development of ColR-E (hazard ratio, 3.875; 95% confidence interval, 1.475–10.184; P = .006). Conclusions Carbapenem-colistin combination therapy did not reduce the incidence of colistin resistance emergence in patients with infections due to carbapenem-resistant organisms. Further studies are necessary to elucidate the development of colistin resistance and methods for its prevention.

Treatment Outcomes of Colistin- and Carbapenem-resistant Acinetobacter baumannii Infections: An Exploratory Subgroup Analysis of a Randomized Clinical Trial

2018 ◽  
Vol 69 (5) ◽  
pp. 769-776 ◽  
Author(s):  
Yaakov Dickstein ◽  
Jonathan Lellouche ◽  
Maayan Ben Dalak Amar ◽  
David Schwartz ◽  
Amir Nutman ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Acinetobacter Baumannii ◽  
Bacterial Infections ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Mortality Rates ◽  
Colistin Resistance ◽  
Randomized Controlled ◽  
Carbapenem Resistant

Abstract Background We evaluated the association between mortality and colistin resistance in Acinetobacter baumannii infections and the interaction with antibiotic therapy. Methods This is a secondary analysis of a randomized controlled trial of patients with carbapenem-resistant gram-negative bacterial infections treated with colistin or colistin-meropenem combination. We evaluated patients with infection caused by carbapenem-resistant A. baumannii (CRAB) identified as colistin susceptible (CoS) at the time of treatment and compared patients in which the isolate was confirmed as CoS with those whose isolates were retrospectively identified as colistin resistant (CoR) when tested by broth microdilution (BMD). The primary outcome was 28-day mortality. Results Data were available for 266 patients (214 CoS and 52 CoR isolates). Patients with CoR isolates had higher baseline functional capacity and lower rates of mechanical ventilation than patients with CoS isolates. All-cause 28-day mortality was 42.3% (22/52) among patients with CoR strains and 52.8% (113/214) among patients with CoS isolates (P = .174). After adjusting for variables associated with mortality, the mortality rate was lower among patients with CoR isolates (odds ratio [OR], 0.285 [95% confidence interval {CI}, .118–.686]). This difference was associated with treatment arm: Mortality rates among patients with CoR isolates were higher in those randomized to colistin-meropenem combination therapy compared to colistin monotherapy (OR, 3.065 [95% CI, 1.021–9.202]). Conclusions Colistin resistance determined by BMD was associated with lower mortality among patients with severe CRAB infections. Among patients with CoR isolates, colistin monotherapy was associated with a better outcome compared to colistin-meropenem combination therapy. Clinical Trials Registration NCT01732250

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