Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin

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 hund...

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Autores: 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
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Recursos:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/95956
Acesso em linha:https://hdl.handle.net/11441/95956
https://doi.org/10.1371/journal.pone.0168468
Access Level:acceso abierto
Palavra-chave:Acinetobacter baumannii Ventilator.
Pneumonia.
High Susceptibility to Colistin.
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spelling Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to ColistinÁlvarez Marín, RocíoLópez-Rojas, RafaelMárquez, Juan AntonioGómez Gómez, María JoséMolina Gil-Bermejo, JoséCisneros, José MiguelAznar Martín, JavierPachón Díaz, JerónimoAcinetobacter baumannii Ventilator.Pneumonia.High Susceptibility to Colistin.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.Ministerio de Economía y Competitividad REIPI RD12/ 0015/0001Public Library Of Science.MedicinaMicrobiologíaCTS203: Estudio de las enfermedades infecciosas2016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfapplication/pdfhttps://hdl.handle.net/11441/95956https://doi.org/10.1371/journal.pone.0168468reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésPlos One, 11 (12), 1-12 p..info:eu-repo/semantics/openAccessoai:idus.us.es:11441/959562026-06-17T12:51:07Z
dc.title.none.fl_str_mv Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
title Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
spellingShingle Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
Álvarez Marín, Rocío
Acinetobacter baumannii Ventilator.
Pneumonia.
High Susceptibility to Colistin.
title_short Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
title_full Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
title_fullStr Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
title_full_unstemmed Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
title_sort Colistin Dosage without Loading Dose Is Efficacious when Treating Carbapenem- Resistant Acinetobacter baumannii Ventilator- Associated Pneumonia Caused by Strains with High Susceptibility to Colistin
dc.creator.none.fl_str_mv 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
author Álvarez Marín, Rocío
author_facet 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
author_role author
author2 López-Rojas, Rafael
Márquez, Juan Antonio
Gómez Gómez, María José
Molina Gil-Bermejo, José
Cisneros, José Miguel
Aznar Martín, Javier
Pachón Díaz, Jerónimo
author2_role author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
Microbiología
CTS203: Estudio de las enfermedades infecciosas
dc.subject.none.fl_str_mv Acinetobacter baumannii Ventilator.
Pneumonia.
High Susceptibility to Colistin.
topic Acinetobacter baumannii Ventilator.
Pneumonia.
High Susceptibility to Colistin.
description 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.
publishDate 2016
dc.date.none.fl_str_mv 2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/95956
https://doi.org/10.1371/journal.pone.0168468
url https://hdl.handle.net/11441/95956
https://doi.org/10.1371/journal.pone.0168468
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Plos One, 11 (12), 1-12 p..
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Public Library Of Science.
publisher.none.fl_str_mv Public Library Of Science.
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
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