Περίληψη:
Background. We evaluated whether carbapenem-colistin combination therapy reduces the emergence of colistin resistance, compared to colistin monotherapy, when given to patients with infections due to carbapenem-resistant Gram-negative organisms. Methods. This is a pre-planned analysis of a secondary outcome from a randomized, controlled trial comparing colistin monotherapy with colistin-meropenem combination for the treatment of severe infections caused by carbapenem-resistant, colistin-susceptible Gram-negative bacteria. We evaluated rectal swabs taken on Day 7 or later for the presence of new colistin-resistant (ColR) isolates. We evaluated the emergence of any ColR isolate and the emergence of ColR Enterobacteriaceae (ColR-E). Results. Data were available for 214 patients for the primary analysis; emergent ColR organisms were detected in 22 (10.3%). No difference was observed between patients randomized to treatment with colistin monotherapy (10/106, 9.4%) versus patients randomized to colistin-meropenem combination therapy (12/108, 11.1%; P = .669). ColR-E organisms were detected in 18/249 (7.2%) patients available for analysis. No difference was observed between the 2 treatment arms (colistin monotherapy 6/128 [4.7%] vs combination therapy 12/121 [9.9%]; P = .111). Enterobacteriaceae, as the index isolate, was found to be associated with development of ColR-E (hazard ratio, 3.875; 95% confidence interval, 1.475–10.184; P = .006). Conclusions. Carbapenem-colistin combination therapy did not reduce the incidence of colistin resistance emergence in patients with infections due to carbapenem-resistant organisms. Further studies are necessary to elucidate the development of colistin resistance and methods for its prevention. © The Author(s) 2019.
Συγγραφείς:
Dickstein, Y.
Lellouche, J.
Schwartz, D.
Nutman, A.
Rakovitsky, N.
Benattar, Y.D.
Altunin, S.
Bernardo, M.
Iossa, D.
Durante-Mangoni, E.
Antoniadou, A.
Skiada, A.
Deliolanis, I.
Daikos, G.L.
Daitch, V.
Yahav, D.
Leibovici, L.
Rognås, V.
Friberg, L.E.
Mouton, J.W.
Paul, M.
Carmeli, Y.
Benattar, Y.D.
Dickstein, Y.
Bitterman, R.
Zayyad, H.
Koppel, F.
Zak-Doron, Y.
Altunin, S.
Andria, N.
Neuberger, A.
Stern, A.
Petersiel, N.
Raines, M.
Karban, A.
Yahav, D.
Eliakim-Raz, N.
Zusman, O.
Elbaz, M.
Atamna, H.
Daitch, V.
Babich, T.
Carmeli, Y.
Nutman, A.
Adler, A.
Levi, I.
Daikos, G.L.
Skiada, A.
Deliolanis, I.
Pavleas, I.
Antoniadou, A.
Kotsaki, A.
Andini, R.
Iossa, D.
Bernardo, M.
Cavezza, G.
Bertolino, L.
Giuffre, G.
Giurazza, R.
Cuccurullo, S.
Galdo, M.
Murino, P.
Cristinziano, A.
Corcione, A.
Zampino, R.
Pafundi, P.C.
Mouton, J.
Friberg, L.
Kristoffersson, A.
Theuretzbacher, U.
the AIDA Study Group
