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  • Dickstein, Yaakov (author)

Colistin Resistance Development Following Colistin-Meropenem Combination Therapy Versus Colistin Monotherapy in Patients With Infections Caused by Carbapenem-Resistant Organisms

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • 2019-11-23
  • Oxford University Press (OUP),2020
  • printrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-429143
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-429143URI
  • https://doi.org/10.1093/cid/ciz1146DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • BACKGROUND: We evaluated whether carbapenem-colistin combination therapy given to patients with infections due to carbapenem-resistant Gram-negative organisms reduces the emergence of colistin resistance compared to colistin monotherapy.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 from enrollment 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%) vs. patients randomized to colistin-meropenem combination therapy (12/108, 11.1%), p=0.669. ColR-E organisms were detected in 18/249 (7.2%) patients available for analysis. No difference was observed between the two treatment arms (colistin monotherapy 6/128 [4.7%] vs. combination therapy 12/121 [9.9%], p=0.111). Enterobacteriaceae as the index isolate was found to be associated with development of ColR-E (HR 3.875 95% CI 1.475-10.184, p=0.006).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.

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  • Lellouche, Jonathan (author)
  • Schwartz, David (author)
  • Nutman, Amir (author)
  • Rakovitsky, Nadya (author)
  • Dishon Benattar, Yael (author)
  • Altunin, Sergey (author)
  • Bernardo, Mariano (author)
  • Iossa, Domenico (author)
  • Durante-Mangoni, Emanuele (author)
  • Antoniadou, Anastasia (author)
  • Skiada, Anna (author)
  • Deliolanis, Ioannis (author)
  • Daikos, George L (author)
  • Daitch, Vered (author)
  • Yahav, Dafna (author)
  • Leibovici, Leonard (author)
  • Rognås, ViktorUppsala universitet,Institutionen för farmaceutisk biovetenskap,Pharmacometrics(Swepub:uu)vikro885 (author)
  • Friberg, Lena E.Uppsala universitet,Institutionen för farmaceutisk biovetenskap,Pharmacometrics(Swepub:uu)lenasimo (author)
  • Mouton, Johan W (author)
  • Paul, Mical (author)
  • Carmeli, Yehuda (author)
  • Uppsala universitetInstitutionen för farmaceutisk biovetenskap (creator_code:org_t)

Related titles

  • In:Clinical Infectious Diseases: Oxford University Press (OUP)71:10, s. 2599-26071058-48381537-6591

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