Sökning: onr:"swepub:oai:DiVA.org:uu-353117" > Colistin alone vers...
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000 | 07453naa a2200589 4500 | |
001 | oai:DiVA.org:uu-353117 | |
003 | SwePub | |
008 | 180611s2018 | |||||||||||000 ||eng| | |
024 | 7 | a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3531172 URI |
024 | 7 | a https://doi.org/10.1016/S1473-3099(18)30099-92 DOI |
040 | a (SwePub)uu | |
041 | a engb eng | |
042 | 9 SwePub | |
072 | 7 | a ref2 swepub-contenttype |
072 | 7 | a art2 swepub-publicationtype |
100 | 1 | a Paul, Micalu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Technion Israel Inst Technol, Fac Med, Haifa, Israel4 aut |
245 | 1 0 | a 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 | 1 | b 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 | 7 | a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Infektionsmedicin0 (SwePub)302092 hsv//swe |
650 | 7 | a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Infectious Medicine0 (SwePub)302092 hsv//eng |
700 | 1 | a Daikos, George L.u Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece4 aut |
700 | 1 | a Durante-Mangoni, Emanueleu Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut |
700 | 1 | a Yahav, Dafnau Beilinson Med Ctr, Infect Dis Unit, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel4 aut |
700 | 1 | 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 |
700 | 1 | a Benattar, Yael Dishonu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Univ Haifa, Cheryl Spencer Dept Nursing, Haifa, Israel4 aut |
700 | 1 | a Skiada, Annau Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece4 aut |
700 | 1 | a Andini, Robertou Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut |
700 | 1 | 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 |
700 | 1 | 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 |
700 | 1 | 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 |
700 | 1 | a Antoniadou, Anastasiau Univ Athens, Athens, Greece;Attikon Univ, Gen Hosp, Dept Med 4, Athens, Greece4 aut |
700 | 1 | a Pafundi, Pia Clarau Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut |
700 | 1 | a Adler, Amosu Tel Aviv Sourasky Med Ctr, Microbiol Lab, Tel Aviv, Israel4 aut |
700 | 1 | a Dickstein, Yaakovu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut |
700 | 1 | a Pavleas, Ioannisu Laikon Gen Hosp, Intens Care Unit, Athens, Greece4 aut |
700 | 1 | a Zampino, Rosau Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy4 aut |
700 | 1 | 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 |
700 | 1 | a Bitterman, Roniu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut |
700 | 1 | a Zayyad, Hibau Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut |
700 | 1 | a Koppel, Fidiu Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel4 aut |
700 | 1 | a Levi, Inbaru Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel4 aut |
700 | 1 | 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 |
700 | 1 | a Friberg, Lena Eu Uppsala universitet,Institutionen för farmaceutisk biovetenskap4 aut0 (Swepub:uu)lenasimo |
700 | 1 | a Mouton, Johan W.u Erasmus MC, Dept Med Microbiol & Infect Dis, Rotterdam, Netherlands4 aut |
700 | 1 | a Theuretzbacher, Ursulau Ctr Antiinfect Agents, Vienna, Austria4 aut |
700 | 1 | 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 |
710 | 2 | 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 |
773 | 0 | t The Lancet - Infectious diseasesd : ELSEVIER SCI LTDg 18:4, s. 391-400q 18:4<391-400x 1473-3099x 1474-4457 |
856 | 4 8 | u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-353117 |
856 | 4 8 | u https://doi.org/10.1016/S1473-3099(18)30099-9 |
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