Artículo
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/es | Álvarez Marín, Rocío
López-Rojas, Rafael Márquez, Juan Antonio Gómez Gómez, María José Molina Gil-Bermejo, José Cisneros, José Miguel Aznar Martín, Javier Pachón Díaz, Jerónimo |
Departamento | Universidad de Sevilla. Departamento de Medicina. Universidad de Sevilla. Departamento de Microbiología |
Fecha de publicación | 2016 |
Fecha de depósito | 2020-04-29 |
Publicado en |
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Resumen | Objectives
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 ... Objectives 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. bau- mannii strains, 99% were non-susceptible to carbapenems and the MIC 90 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 set- ting of high susceptibility to colistin of A. baumannii. |
Cita | Álvarez Marín, R., López-Rojas, R., Márquez, J.A., Gómez Gómez, M.J., Molina Gil-Bermejo, J., Cisneros, J.M.,...,Pachón Díaz, J. (2016). 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, 11 (12), 1-12 p.. |
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