TY - JOUR
T1 - The Association Between Empirical Antibiotic Treatment and Mortality in Severe Infections Caused by Carbapenem-resistant Gram-negative Bacteria
T2 - A prospective study
AU - AIDA Study Group
AU - Zak-Doron, Yael
AU - Benattar, Yael Dishon
AU - Pfeffer, Iris
AU - Daikos, George L.
AU - Skiada, Anna
AU - Antoniadou, Anastasia
AU - Durante-Mangoni, Emanuele
AU - Andini, Roberto
AU - Cavezza, Giusi
AU - Leibovici, Leonard
AU - Yahav, Dafna
AU - Eliakim-Raz, Noa
AU - Carmeli, Yehuda
AU - Nutman, Amir
AU - Paul, Mical
AU - Dickstein, Yaakov
AU - Bitterman, Roni
AU - Zayyad, Hiba
AU - Koppel, Fidi
AU - Altunin, Sergey
AU - Andria, Nizar
AU - Neuberger, Ami
AU - Stern, Anat
AU - Petersiel, Neta
AU - Raines, Marina
AU - Karban, Amir
AU - Zusman, Oren
AU - Elbaz, Michal
AU - Atamna, Heyam
AU - Daitch, Vered
AU - Babich, Tanya
AU - Adler, Amos
AU - Levi, Inbar
AU - Daikos, George L.
AU - Pavleas, Ioannis
AU - Kotsaki, Antigoni
AU - Iossa, Domenico
AU - Bernardo, Mariano
AU - Bertolino, Lorenzo
AU - Giuffrè, Giuseppe
AU - Giurazza, Roberto
AU - Cuccurullo, Susanna
AU - Galdo, Maria
AU - Murino, Patrizia
AU - Cristinziano, Adriano
AU - Corcione, Antonio
AU - Zampino, Rosa
AU - Pafundi, Pia Clara
AU - Mouton, Johan
AU - Friberg, Lena
N1 - Publisher Copyright:
© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected].
PY - 2018
Y1 - 2018
N2 - Background. Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods. This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching. Results. The study included 406 inpatients with severe CRGNB infections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02-1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score-matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91-2.22). Similar results were obtained in an analysis of 14-day mortality. Conclusions. Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.
AB - Background. Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB). Methods. This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching. Results. The study included 406 inpatients with severe CRGNB infections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02-1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score-matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91-2.22). Similar results were obtained in an analysis of 14-day mortality. Conclusions. Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.
KW - Appropriate empirical antibiotics
KW - Carbapenemase-producing
KW - Colistin
KW - Gram-negative bacteria
KW - Multidrug-resistant bacteria
UR - http://www.scopus.com/inward/record.url?scp=85057530481&partnerID=8YFLogxK
U2 - 10.1093/cid/ciy371
DO - 10.1093/cid/ciy371
M3 - Article
C2 - 29718143
AN - SCOPUS:85057530481
SN - 1058-4838
VL - 67
SP - 1815
EP - 1823
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -