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Sökning: onr:"swepub:oai:DiVA.org:uu-353117" > Colistin alone vers...

LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00007453naa a2200589 4500
001oai:DiVA.org:uu-353117
003SwePub
008180611s2018 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3531172 URI
0247 a https://doi.org/10.1016/S1473-3099(18)30099-92 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Paul, Micalu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Technion Israel Inst Technol, Fac Med, Haifa, Israel4 aut
2451 0a Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria :b an open-label, randomised controlled trial
264 1b ELSEVIER SCI LTD,c 2018
338 a print2 rdacarrier
520 a Background: Colistin-carbapenem combinations are synergistic in vitro against carbapenem-resistant Gram-negative bacteria. We aimed to test whether combination therapy improves clinical outcomes for adults with infections caused by carbapenem-resistant or carbapenemase-producing Gram-negative bacteria.Methods: A randomised controlled superiority trial was done in six hospitals in Israel, Greece, and Italy. We included adults with bacteraemia, ventilator-associated pneumonia, hospital-acquired pneumonia, or urosepsis caused by carbapenem-non-susceptible Gram-negative bacteria. Patients were randomly assigned (1:1) centrally, by computer-generated permuted blocks stratified by centre, to intravenous colistin (9-million unit loading dose, followed by 45 million units twice per day) or colistin with meropenem (2-g prolonged infusion three times per day). The trial was open-label, with blinded outcome assessment. Treatment success was defined as survival, haemodynamic stability, improved or stable Sequential Organ Failure Assessment score, stable or improved ratio of partial pressure of arterial oxygen to fraction of expired oxygen for patients with pneumonia, and microbiological cure for patients with bacteraemia. The primary outcome was clinical failure, defined as not meeting all success criteria by intention-to-treat analysis, at 14 days after randomisation. This trial is registered at ClinicalTrials.gov, number NCT01732250, and is closed to accrual.Findings: Between Oct 1, 2013, and Dec 31, 2016, we randomly assigned 406 patients to the two treatment groups. Most patients had pneumonia or bacteraemia (355/406, 87%), and most infections were caused by Acinetobacter baumannii (312/406, 77%). No significant difference between colistin monotherapy (156/198, 79%) and combination therapy (152/208, 73%) was observed for clinical failure at 14 days after randomisation (risk difference -5.7%, 95% CI -13.9 to 2.4; risk ratio [RR] 0.93, 95% CI 0.83-1.03). Results were similar among patients with A baumannii infections (RR 0.97, 95% CI 0.87-1.09). Combination therapy increased the incidence of diarrhoea (56 [27%] vs 32 [16%] patients) and decreased the incidence of mild renal failure (37 [30%] of 124 vs 25 [20%] of 125 patients at risk of or with kidney injury).Interpretation: Combination therapy was not superior to monotherapy. The addition of meropenem to colistin did not improve clinical failure in severe A baumannii infections. The trial was unpowered to specifically address other bacteria.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Infektionsmedicin0 (SwePub)302092 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Infectious Medicine0 (SwePub)302092 hsv//eng
7001 a Daikos, George L.u Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece4 aut
7001 a Durante-Mangoni, Emanueleu Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut
7001 a Yahav, Dafnau Beilinson Med Ctr, Infect Dis Unit, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut
7001 a Carmeli, Yehudau Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel;Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel4 aut
7001 a Benattar, Yael Dishonu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Univ Haifa, Cheryl Spencer Dept Nursing, Haifa, Israel4 aut
7001 a Skiada, Annau Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece4 aut
7001 a Andini, Robertou Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut
7001 a Eliakim-Raz, Noau Beilinson Med Ctr, Infect Dis Unit, Petah Tiqwa, Israel;Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut
7001 a Nutman, Amiru Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel;Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel4 aut
7001 a Zusman, Orenu Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut
7001 a Antoniadou, Anastasiau Univ Athens, Athens, Greece;Attikon Univ, Gen Hosp, Dept Med 4, Athens, Greece4 aut
7001 a Pafundi, Pia Clarau Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut
7001 a Adler, Amosu Tel Aviv Sourasky Med Ctr, Microbiol Lab, Tel Aviv, Israel4 aut
7001 a Dickstein, Yaakovu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut
7001 a Pavleas, Ioannisu Laikon Gen Hosp, Intens Care Unit, Athens, Greece4 aut
7001 a Zampino, Rosau Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut
7001 a Daitch, Veredu Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut
7001 a Bitterman, Roniu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut
7001 a Zayyad, Hibau Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut
7001 a Koppel, Fidiu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut
7001 a Levi, Inbaru Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel4 aut
7001 a Babich, Tanyau Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut
7001 a Friberg, Lena Eu Uppsala universitet,Institutionen för farmaceutisk biovetenskap4 aut0 (Swepub:uu)lenasimo
7001 a Mouton, Johan W.u Erasmus MC, Dept Med Microbiol & Infect Dis, Rotterdam, Netherlands4 aut
7001 a Theuretzbacher, Ursulau Ctr Antiinfect Agents, Vienna, Austria4 aut
7001 a Leibovici, Leonardu Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut
7102 a Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Technion Israel Inst Technol, Fac Med, Haifa, Israelb Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece4 org
7730 t The Lancet - Infectious diseasesd : ELSEVIER SCI LTDg 18:4, s. 391-400q 18:4<391-400x 1473-3099x 1474-4457
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-353117
8564 8u https://doi.org/10.1016/S1473-3099(18)30099-9

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