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Treatment pattern, prognostic factors, and outcome in patients with infection due to pan-drug-resistant gram-negative bacteria
Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Crete, Greece.
Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece.
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2020 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373Article in journal (Refereed) Epub ahead of print
Abstract [en]

The present study investigated the clinical course, treatment pattern, prognostic factors, and outcome of patients with pun-drug resistant (PDR) infections. This was a retrospective single-center cohort study including consecutive eligible patients with a PDR infection hospitalized at the University Hospital of Heraklion, Crete, Greece, between January 2010 and June 2018. In total, 65 patients with infections due to PDR gram-negative pathogens were identified. The median age was 64 years (interquartile range, IQR: 45.5-74.5) and the median Charlson comorbidity index 3.0 (IQR: 1.0-5.75). Of the 65 PDR isolates, 31 (48%) were Klebsiella pneumoniae, 28 (43%) Acinetobacter baumannii, and 6 (9%) Pseudomonas aeruginosa. The most common empirical therapy was colistin-based combination (n = 32; 49%), followed by non-colistin, non-tigecycline combination (n = 25; 39%), and carbapenemes + tigecycline (n = 8; 12%). The empirical therapy was effective in 50%, 37.5%, and 8% of patients receiving colistin combination, carbapenemes - tigecycline, and non-colistin, non-tigecycline combination, respectively (p value = 0.003). The infection-related in-hospital mortality was 32% (95% confidence interval, CI: 21-45%). Three factors were significantly associated with infection-related in-hospital mortality in multivariate analysis: Charlson comorbidity index (odds ratio, OR: 1.5, 95% CI: 1.0-2.3, p value = 0.030), prior steroid use (OR: 4.1, 95% CI: 1.0-17.0, p value = 0.049), and empirical treatment with non-colistin, non-tigecycline combination (OR: 7.5; 95% CI: 1.7-32.8, p value = 0.008). Infections due to PDR pathogens are associated with considerable mortality. Our results support the use of colistin and/or tigecycline-based combinations as empirical therapy when infection due to PDR pathogens is suspected.

Place, publisher, year, edition, pages
Springer, 2020.
Keywords [en]
Acinetobacter baumannii, Colistin, Klebsiella pneumonia, Pan-drug-resistant bacteria, Pseudomonas aeruginosa
National Category
Infectious Medicine
Identifiers
URN: urn:nbn:se:oru:diva-79786DOI: 10.1007/s10096-019-03784-9PubMedID: 31933017OAI: oai:DiVA.org:oru-79786DiVA, id: diva2:1391935
Available from: 2020-02-05 Created: 2020-02-05 Last updated: 2020-03-03Bibliographically approved

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Valachis, Antonis

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