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. 2017 Dec;21(12):825-829.
doi: 10.4103/ijccm.IJCCM_243_17.

Monotherapy versus Combination Therapy against Nonbacteremic Carbapenem-resistant Gram-negative Infections: A Retrospective Observational Study

Abdul Ghafur  1 , Vidyalakshmi Devarajan  1 , T Raja  2 , Jose Easow  2 , M A Raja  2 , Sankar Sreenivas  2 , Balasubramaniam Ramakrishnan  3 , S G Raman  2 , Dedeepiya Devaprasad  4 , Balaji Venkatachalam  4 , Ramesh Nimmagadda  2
Affiliations

Monotherapy versus Combination Therapy against Nonbacteremic Carbapenem-resistant Gram-negative Infections: A Retrospective Observational Study

Abdul Ghafur et al. Indian J Crit Care Med. 2017 Dec.

Abstract

Background: Superiority of colistin-carbapenem combination therapy (CCCT) over colistin monotherapy (CMT) against carbapenem-resistant Gram-negative bacterial (CRGNB) infections is not conclusively proven.

Aim: The aim of the current study was to analyze the effectiveness of both strategies against CRGNB nonbacteremic infections.

Design: This was a retrospective observational cohort study.

Subjects and methods: Case record analysis of patients who had CRGNB nonbacteremic infections identified over a period of 4 years (January 2012-December 2015) was done by medical record review at a tertiary care center in India.

Statistical analysis: P < 0.05 was considered as significant. Multivariate analysis was performed using Cox regression.

Results: Out of 153 patients (pneumonia 115, urinary tract infection 17, complicated skin and soft-tissue infection 18, intra-abdominal infection 1, and meningitis 2), 92 patients received CCCT and 61 received CMT. Univariate analysis revealed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, pneumonia as the diagnosis, and Klebsiella as the causative organism to be the risk factors for higher 28-day mortality (P = 0.036, 0.006, 0.016, respectively). Combination therapy had no significant impact on mortality (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.327-2.535, P = 0.857). Multivariate analysis revealed that higher APACHE II score and infection due to Klebsiella were found to be independent risk factors for higher mortality (OR = 3.16 and 4.9, 95% CI = 1.34-7.4 and 2.19-11.2, P = 0.008 and 0.0001, respectively).

Conclusions: In our retrospective single-center series of CRGNB nonbacteremic infections, CCCT was not superior to CMT. Multicenter large observational studies or prospective randomized clinical trials are the need of the hour.

Keywords: Colistin-based combination therapy; Gram-negative bacteria; New Delhi metallo-beta-lactamase; colistin monotherapy; extensively drug resistant.

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Conflict of interest statement

There are no conflicts of interest.

References

    1. Kim YJ, Kim SI, Hong KW, Kim YR, Park YJ, Kang MW, et al. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: Impact of appropriate antimicrobial therapy. J Korean Med Sci. 2012;27:471–5. - PMC - PubMed
    1. Andria N, Henig O, Kotler O, Domchenko A, Oren I, Zuckerman T, et al. Mortality burden related to infection with carbapenem-resistant gram-negative bacteria among haematological cancer patients: A retrospective cohort study. J Antimicrob Chemother. 2015;70:3146–53. - PubMed
    1. Ghafur A, Mathai D, Muruganathan A, Jayalal JA, Kant R, Chaudhary D, et al. The Chennai declaration: A roadmap to tackle the challenge of antimicrobial resistance. Indian J Cancer. 2013;50:71–3. - PubMed
    1. Falagas ME, Lourida P, Poulikakos P, Rafailidis PI, Tansarli GS. Antibiotic treatment of infections due to carbapenem-resistant enterobacteriaceae: Systematic evaluation of the available evidence. Antimicrob Agents Chemother. 2014;58:654–63. - PMC - PubMed
    1. Tumbarello M, Viale P, Viscoli C, Trecarichi EM, Tumietto F, Marchese A, et al. Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: Importance of combination therapy. Clin Infect Dis. 2012;55:943–50. - PubMed

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