Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/2595
Título : Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin.
Autor : Álvarez-Marín, Rocío
López-Rojas, Rafael
Márquez, Juan Antonio
Gómez, María José
Molina, José
Cisneros, José Miguel
Ortiz-Leyba, Carlos
Aznar, Javier
Garnacho-Montero, José
Pachón, Jerónimo
Filiación: [Álvarez-Marín,R; López-Rojas,R; Gómez,MJ; Molina,J; Cisneros,MJ; Aznar,J; Pachón,J] Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine Infectious Diseases Research Group Institute of Biomedicine of Seville (IBiS) University of Seville/CSIC/University Hospitals Virgen del Rocio and Virgen Macarena, Seville, Spain. [Márquez,JA; Ortiz-Leyba,C] Clinical Unit of Critical Care and Emergencies, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain. [Garnacho-Montero,J] Clinical Unit of Critical Care, University Hospital Virgen Macarena, Seville, Spain.
Palabras clave : Acinetobacter baumannii
Lesión renal aguda
Antibacterianos
Bacteriemia
Colistina
Unidades de cuidados intensivos
MeSH: Medical Subject Headings::Organisms::Bacteria::Gram-Negative Bacteria::Gram-Negative Aerobic Bacteria::Gram-Negative Aerobic Rods and Cocci::Moraxellaceae::Acinetobacter::Acinetobacter baumannii
Medical Subject Headings::Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Acute Kidney Injury
Medical Subject Headings::Named Groups::Persons::Age Groups::Adult
Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents
Medical Subject Headings::Diseases::Bacterial Infections and Mycoses::Bacterial Infections::Bacteremia
Medical Subject Headings::Chemicals and Drugs::Organic Chemicals::Amides::Lactams::beta-Lactams::Carbapenems
Medical Subject Headings::Chemicals and Drugs::Polycyclic Compounds::Macrocyclic Compounds::Peptides, Cyclic::Polymyxins::Colistin
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospital Units::Intensive Care Units
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Analysis of Variance::Multivariate Analysis
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Airway Management::Respiration, Artificial
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Survival Analysis
Fecha de publicación : 19-Dec-2016
Editorial : Public Library of Science
Cita Bibliográfica: Álvarez-Marín R, López-Rojas R, Márquez JA, Gómez MJ, Molina J, Cisneros JM, et al. Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin. PLoS One. 2016;11(12):e0168468.
Abstract: This study aims to analyze the mortality and the length of ICU stay (LOS) of A. baumannii VAP compared to respiratory colonization in patients with mechanical ventilation (MV). METHODS:A prospective cohort study was performed in an ICU of adult patients (February 2010-June 2011). One hundred patients on MV with A. baumannii in lower respiratory airways were recruited, and classified as VAP or airways colonization according to CPIS criteria, with a punctuation ≥6. LOS, 30-days mortality, A. baumannii bacteremia, and clinical features including antibiotic therapy were recorded. Multivariate analysis (linear and Cox regression) and survival analysis (Kaplan-Meier curves) were performed. RESULTS:Fifty-seven VAP and 43 colonized A. baumannii patients were analyzed. Among the A. baumannii strains, 99% were non-susceptible to carbapenems and the MIC90 of colistin was 0.12 mg/l. Therapy was appropriate in 94.6% of VAP patients, most of them with colistin 6 MIU/day, although in 13 (23.6%) cases colistin was started 48 hours after the onset of VAP. Mortality was similar in both groups (VAP 24.6% vs. colonized 27.9%, p = 0.7). Bacteremia and acute kidney insufficiency were associated with decreased survival (p = 0.02 and p = 0.04, respectively) in VAP patients. LOS was 21.5 (11.5-42.75) vs. 9 (6-22) days for VAP and colonized patients (p = 0.004). VAP (p = 0.003) and age (p = 0.01) were independently related to a longer LOS. CONCLUSIONS:Multidrug-resistant A. baumannii VAP treated with colistin does not have a different mortality compared to lower airways colonization, among patients on mechanical-ventilation, in a setting of high susceptibility to colistin of A. baumannii.
URI: http://hdl.handle.net/10668/2595
Versión del editor : http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168468
DOI: 10.1371/journal.pone.0168468. eCollection 2016.
ISSN : 1932-6203 (Online)
Appears in Collections:01- Artículos - IBIS. Instituto de Biomedicina de Sevilla
01- Artículos - Hospital Virgen del Rocío
01- Artículos - Hospital Virgen Macarena

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