Safety and effectiveness of colistin compared with tobramycin for multi-drug resistant Acinetobacter baumannii infections.
Safety and effectiveness of colistin compared with tobramycin for multi-drug resistant Acinetobacter baumannii infections.
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DOI：
10.1186/1471-2334-9-26
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发表时间：
2009-03-09
影响因子：
3.7
通讯作者：
Maartens G
中科院分区：
文献类型：
--
作者：
Gounden R;Bamford C;van Zyl-Smit R;Cohen K;Maartens G
由多重耐药鲍曼不动杆菌引起的医院感染通常使用粘菌素治疗，但很少有数据将其与其他抗菌药的安全性和有效性进行比较。Groote Schuur医院重症监护病房(ICU)应用粘菌素或妥布霉素治疗鲍曼不动杆菌感染患者的回顾性队列研究。粘菌素用于鲍曼不动杆菌分离株，这些分离株对所有其他可用的抗菌素都有抗药性。在妥布霉素组，53%的分离株只对妥布霉素和粘菌素敏感。我们评估了ICU死亡率、肾毒性和首次阴性培养的时间。32例入院APACHE评分和血肌酐相似的患者接受了两种抗菌药的治疗。粘菌素组和妥布霉素组在ICU死亡率(p=0.54)、肾毒性(p=0.67)、肌酐从基线到最高值的变化(p=0.11)和微生物清除时间(p=0.75)方面没有显著差异。与妥布霉素相比，接受粘菌素治疗的患者的总住院生存风险比为0.43(95%CI为0.19至0.99)。我们的研究表明，粘菌素和妥布霉素具有相似的肾毒性风险，并且同样有效。当鲍曼不动杆菌对其他可用的抗菌剂有抗药性时，粘菌素是一种可以接受的治疗鲍曼不动杆菌感染的抗生素。
Nosocomial infections due to multi-drug resistant Acinetobacter baumannii are often treated with colistin, but there are few data comparing its safety and efficacy with other antimicrobials. A retrospective cohort study of patients treated with colistin or tobramycin for A. baumannii infections in intensive care units (ICUs) at Groote Schuur hospital. Colistin was used for A. baumannii isolates which were resistant to all other available antimicrobials. In the tobramycin group, 53% of the isolates were only susceptible to tobramycin and colistin. We assessed ICU mortality, nephrotoxicity and time to the first negative culture. 32 patients, with similar admission APACHE scores and serum creatinine, were treated with each antimicrobial. There were no significant differences between the colistin and tobramycin groups in ICU mortality (p = 0.54), nephrotoxicity (p = 0.67), change in creatinine from baseline to highest subsequent value (p = 0.11) and time to microbiological clearance (p = 0.75). The hazard ratio for total in-hospital survival in patients treated with colistin compared to tobramycin was 0.43 (95% CI 0.19 to 0.99). Our study suggests that colistin and tobramycin have similar risks of nephrotoxicity and are equally efficacious. Colistin is an acceptable antibiotic for the treatment of A. baumanii infections when the organism is resistant to other available antimicrobials.
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DOI：
10.1186/cc2358
发表时间：
2003-10
期刊：
Critical care (London, England)
影响因子：
--
作者：
Markou N;Apostolakos H;Koumoudiou C;Athanasiou M;Koutsoukou A;Alamanos I;Gregorakos L
通讯作者：
Gregorakos L
影响因子：
15.1
作者：
Falagas, Matthew E.;Kasiakou, Sofia K.
通讯作者：
Kasiakou, Sofia K.
影响因子：
4.9
作者：
Li, Jian;Rayner, Craig R.;Liojios, Lisa
通讯作者：
Liojios, Lisa
影响因子：
2.7
作者：
Berlana, D;Llop, JM;Jódar, R
通讯作者：
Jódar, R
影响因子：
11.8
作者：
Garnacho-Montero, J;Ortiz-Leyba, C;Madrazo-Osuna, J
通讯作者：
Madrazo-Osuna, J