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Colistin alone vers...
Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria : an open-label, randomised controlled trial
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- Paul, Mical (författare)
- Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Technion Israel Inst Technol, Fac Med, Haifa, Israel
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- Daikos, George L. (författare)
- Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece
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- Durante-Mangoni, Emanuele (författare)
- Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy
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- Yahav, Dafna (författare)
- Beilinson Med Ctr, Infect Dis Unit, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel
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- Carmeli, Yehuda (författare)
- Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel;Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
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- Benattar, Yael Dishon (författare)
- Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel;Univ Haifa, Cheryl Spencer Dept Nursing, Haifa, Israel
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- Skiada, Anna (författare)
- Laikon Gen Hosp, Dept Med 1, Athens, Greece;Univ Athens, Athens, Greece
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- Andini, Roberto (författare)
- Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy
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- Eliakim-Raz, Noa (författare)
- 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, Israel
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- Nutman, Amir (författare)
- Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel;Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
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- Zusman, Oren (författare)
- Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel
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- Antoniadou, Anastasia (författare)
- Univ Athens, Athens, Greece;Attikon Univ, Gen Hosp, Dept Med 4, Athens, Greece
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- Pafundi, Pia Clara (författare)
- Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy
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- Adler, Amos (författare)
- Tel Aviv Sourasky Med Ctr, Microbiol Lab, Tel Aviv, Israel
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- Dickstein, Yaakov (författare)
- Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel
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- Pavleas, Ioannis (författare)
- Laikon Gen Hosp, Intens Care Unit, Athens, Greece
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- Zampino, Rosa (författare)
- Univ Campania L Vanvitelli, Internal Med, Naples, Italy;AORN Colli Monaldi Hosp, Naples, Italy
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- Daitch, Vered (författare)
- Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel
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- Bitterman, Roni (författare)
- Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel
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- Zayyad, Hiba (författare)
- Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel
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- Koppel, Fidi (författare)
- Rambam Hlth Care Campus, Inst Infect Dis, IL-3109601 Haifa, Israel
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- Levi, Inbar (författare)
- Tel Aviv Sourasky Med Ctr, Div Epidemiol & Prevent Med, Tel Aviv, Israel
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- Babich, Tanya (författare)
- Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel
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- Friberg, Lena E (författare)
- Uppsala universitet,Institutionen för farmaceutisk biovetenskap
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- Mouton, Johan W. (författare)
- Erasmus MC, Dept Med Microbiol & Infect Dis, Rotterdam, Netherlands
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- Theuretzbacher, Ursula (författare)
- Ctr Antiinfect Agents, Vienna, Austria
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- Leibovici, Leonard (författare)
- Beilinson Med Ctr, Dept Med E, Rabin Med Ctr, Petah Tiqwa, Israel;Tel Aviv Univ, Sackler Fac Med, Ramat Aviv, Israel
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(creator_code:org_t)
- ELSEVIER SCI LTD, 2018
- 2018
- Engelska.
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Ingår i: The Lancet - Infectious diseases. - : ELSEVIER SCI LTD. - 1473-3099 .- 1474-4457. ; 18:4, s. 391-400
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Infektionsmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Infectious Medicine (hsv//eng)
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Paul, Mical
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Daikos, George L ...
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Durante-Mangoni, ...
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Yahav, Dafna
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Carmeli, Yehuda
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Benattar, Yael D ...
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visa fler...
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Skiada, Anna
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Andini, Roberto
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Eliakim-Raz, Noa
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Nutman, Amir
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Zusman, Oren
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Antoniadou, Anas ...
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Pafundi, Pia Cla ...
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Adler, Amos
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Dickstein, Yaako ...
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Pavleas, Ioannis
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Zampino, Rosa
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Daitch, Vered
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Bitterman, Roni
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Zayyad, Hiba
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Koppel, Fidi
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Levi, Inbar
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Babich, Tanya
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Friberg, Lena E
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Mouton, Johan W.
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Theuretzbacher, ...
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Leibovici, Leona ...
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The Lancet - Inf ...
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Uppsala universitet