RT Journal Article
T1 Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
A1 Alvarez-Marin, Rocio
A1 Lopez-Rojas, Rafael
A1 Antonio Marquez, Juan
A1 Jose Gomez, Maria
A1 Molina, Jose
A1 Miguel Cisneros, Jose
A1 Ortiz-Leyba, Carlos
A1 Aznar, Javier
A1 Garnacho-Montero, Jose
A1 Pachon, Jeronimo
K1 Critically-ill patients
K1 Intensive-care-unit
K1 Risk-factors
K1 Attributable mortality
K1 Multidrug-resistant
K1 Clinical-features
K1 Multiplex pcr
K1 Infection
K1 Impact
K1 Methanesulfonate
AB ObjectivesThis 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).MethodsA 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.ResultsFifty-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.ConclusionsMultidrug-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.
PB Public library science
SN 1932-6203
YR 2016
FD 2016-12-19
LK http://hdl.handle.net/10668/19171
UL http://hdl.handle.net/10668/19171
LA en
DS RISalud
RD Apr 11, 2025