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1.
Med Sci Monit ; 25: 174-183, 2019 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-30614487

RESUMEN

BACKGROUND We investigated the factors affecting antibiotic resistance in the intensive care unit (ICU)-related hospital-acquired infections caused by Klebsiella pneumoniae (KP-HAI) and the effects of antibiotics used for high-level antibiotic resistance on patient survival. MATERIAL AND METHODS This retrospective study was performed at the adult ICU of Bezmialem Vakif University Hospital. Patients who were followed up between 01 January 2012 and 31 May 2017 were evaluated. Each KP strain was categorized according to resistance patterns and analyzed. The efficiency of antibiotic therapy for highly-resistant KP-HAI was determined by patients' lifespans. RESULTS We evaluated 208 patients. With the prior use of carbapenem, antibiotics against resistant Gram-positives, and tigecycline, it was observed that the resistance rate of the infectious agents had a significant increase. As the resistance category increases, a significant decrease was seen in the survival time. We observed that if the treatment combination included trimethoprim-sulfamethoxazole, the survival time became significantly longer, and tigecycline-carbapenem-colistin and tigecycline-carbapenem combination patients showed significantly shorter survival times. CONCLUSIONS When the resistance increases, delays will occur in starting suitable and effective antibiotic treatment, with increased sepsis frequency and higher mortality rates. Trimethoprim-sulfamethoxazole can be an efficient alternative to extend survival time in trimethoprim-sulfamethoxazole-susceptible KP infections that have extensive drug resistance.


Asunto(s)
Farmacorresistencia Microbiana/efectos de los fármacos , Infecciones por Klebsiella/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/farmacología , Adulto , Anciano , Antibacterianos/farmacología , Carbapenémicos/farmacología , Carbapenémicos/uso terapéutico , Colistina/farmacología , Colistina/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Bacteriana/fisiología , Femenino , Humanos , Unidades de Cuidados Intensivos , Infecciones por Klebsiella/mortalidad , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/patogenicidad , Masculino , Persona de Mediana Edad , Neumonía , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Tigeciclina/farmacología , Tigeciclina/uso terapéutico , Resultado del Tratamiento
2.
Scand J Infect Dis ; 46(10): 678-85, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-25073536

RESUMEN

BACKGROUND: Colistin (COL) has become the backbone of the treatment of infections due to extensively drug-resistant (XDR) Gram-negative bacteria. The most common restriction to its use is acute kidney injury (AKI). METHODS: We conducted a retrospective cohort study to evaluate risk factors for new-onset AKI in patients receiving COL. The cohort consisted of 198 adults admitted to 9 referral hospitals between January 2010 and October 2012 and treated with intravenous COL for ≥ 72 h. Patients with no pre-existing kidney dysfunction were compared in terms of risk factors and outcomes of AKI graded according to the RIFLE criteria. Logistic regression analysis was used to identify associated risk factors. RESULTS: A total of 198 patients met the inclusion criteria, of whom 167 had no pre-existing kidney dysfunction; the mean patient age was 58.77 (± 18.98) y. Bloodstream infections (34.8%) and ventilator-associated pneumonia (32.3%) were the 2 most common indications for COL use. New-onset AKI developed in 46.1% of the patients, graded as risk (10%), injury (15%), and failure (21%). Patients with high Charlson co-morbidity index (CCI) scores (p = 0.001) and comparatively low initial glomerular filtration rate (GFR) estimations (p < 0.001) were more likely to develop AKI, but older age (p = 0.001; odds ratio 5.199, 95% confidence interval 2.684-10.072) was the major predictor in the multivariate analysis. In-hospital recovery from AKI occurred in 58.1%, within a median of 7 days. CONCLUSIONS: COL-induced nephrotoxicity occurred significantly more often in patients older than 60 y of age and was related to low initial GFR estimations and high CCI scores, which were basically determined by age.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Antibacterianos/efectos adversos , Colistina/efectos adversos , Administración Intravenosa , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Estudios de Cohortes , Colistina/administración & dosificación , Comorbilidad , Femenino , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
3.
J Glob Antimicrob Resist ; 14: 190-196, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29751127

RESUMEN

OBJECTIVES: This study assessed trends and patterns in antimicrobial-resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey. METHODS: Bacterial culture and antimicrobial susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital in 2012-2015. Multiresistance patterns were categorised as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Temporal patterns and trends were assessed using regression analyses. RESULTS: Of 991 pathogenic GNB recorded, the most frequent were Acinetobacter baumannii (35.3%), Klebsiella spp. (26.7%), Pseudomonas aeruginosa (18.1%) and Escherichia coli (6.7%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared with 2015 (P<0.001), mostly representing decreases in bloodstream infections and pneumonias by A. baumannii and P. aeruginosa. The XDR proportion in A. baumannii increased from 52.4% in 2012 to 71.7% in 2015, but only one isolate was colistin-resistant. Multiresistance patterns remained stable in Klebsiella, with overall XDR and possible PDR proportions of 14.3% and 1.9%, respectively. A back-to-susceptibility trend was noted for P. aeruginosa in which the non-MDR proportion increased from 53.3% in 2012 to 70.6% in 2015. Moreover, 87.9% of E. coli and 39.5% of Enterobacter isolates were MDR, but none was XDR. CONCLUSIONS: Antimicrobial resistance patterns in pathogenic GNB continuously change over time and may not reflect single-agent resistance trends. The proportionate amount of antimicrobial-resistant GNB may persist despite overall decreasing infection rates. Timely regional surveillance data are thus imperative for optimal infection control.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/epidemiología , Acinetobacter baumannii , Anciano , Estudios de Cohortes , Escherichia coli , Femenino , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/clasificación , Humanos , Unidades de Cuidados Intensivos , Klebsiella , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Vigilancia de la Población , Pseudomonas aeruginosa , Análisis de Regresión , Análisis Espacio-Temporal , Turquía/epidemiología
4.
Clin Neurol Neurosurg ; 153: 43-49, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28013184

RESUMEN

AIM: To examine the variables associated with mortality in patients with Acinetobacter baumannii-related central nervous system infections treated with intrathecal colistin. MATERIALS AND METHODS: This multi-centre retrospective case control study included patients from 11 centres in Turkey, as well as cases found during a literature review. Only patients with CNS infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii treated with intrathecal colistin were included in this study. The variables associated with mortality were determined by dividing the patients into groups who died or survived during hospitalisation, and who died or survived from Acinetobacter meningitis. RESULTS: Among the 77 cases enrolled in the study, 35 were found through a literature review and 42 were cases from our centres. Forty-four cases (57.1%) were male and the median age was 48 years (range: 20-78 years). Thirty-seven patients (48%) died during hospitalisation. The variables associated with increased all-cause mortality during hospitalisation included old age (odds ratio, 1.035; 95% confidence interval (CI), 1.004-1.067; p=0.026) and failure to provide cerebrospinal fluid sterilisation (odds ratio, 0.264; 95% confidence interval, 0.097-0.724; p=0.01). There is a trend (P=0.062) towards higher mortality with using of meropenem during meningitis treatment. Fifteen cases (19%) died from meningitis. There were no significant predictors of meningitis-related mortality. CONCLUSIONS: The mortality rate for central nervous system infections caused by multidrug-resistant or extensively drug-resistant Acinetobacter baumannii is high. Old age and failure to provide CSF sterilisation are associated with increased mortality during hospitalisation.


Asunto(s)
Infecciones por Acinetobacter/mortalidad , Acinetobacter baumannii/patogenicidad , Antibacterianos/farmacología , Ventriculitis Cerebral/mortalidad , Colistina/farmacología , Meningitis Bacterianas/mortalidad , Evaluación de Resultado en la Atención de Salud , Tienamicinas/farmacología , Infecciones por Acinetobacter/epidemiología , Adulto , Anciano , Antibacterianos/administración & dosificación , Estudios de Casos y Controles , Ventriculitis Cerebral/epidemiología , Colistina/administración & dosificación , Femenino , Humanos , Inyecciones Espinales , Masculino , Meningitis Bacterianas/epidemiología , Meropenem , Persona de Mediana Edad , Estudios Retrospectivos , Tienamicinas/administración & dosificación , Adulto Joven
5.
Cornea ; 32(7): 1052-7, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23665649

RESUMEN

PURPOSE: To compare the efficacy of topical linezolid (LZD) 1 mg/mL or 2 mg/mL to vancomycin (VA) 50 mg/mL for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in rabbits. METHODS: One hundred colony-forming unit (CFU) MRSA bacteria were injected intrastromally into rabbit corneas. Sixteen hours after the injection, 24 rabbits were randomly divided into 4 groups. Rabbit eyes were treated with 1 drop of topical LZD 1 mg/mL, LZD 2 mg/mL, VA 50 mg/mL, or isotonic saline every 15 minutes for 5 doses and then every 30 minutes for 14 doses. Eyes were examined before and after the treatment using slit-lamp biomicroscopy by 2 observers blinded to the study for the determination of clinical severity. Then, corneas were harvested for the quantification of bacteria and histopathology. RESULTS: There were no differences in clinical severity among the groups before and after the treatment in each eye. The mean CFU × 10(6) of MRSA recovered from the LZD 1 mg/mL, LZD 2 mg/mL, and VA 50 mg/mL groups were significantly lower than that recovered from corneas treated with isotonic saline. There was no statistically significant difference among the treatment groups in terms of CFU × 10(6). Epithelial erosion in the VA 50 mg/mL group was significantly worse than that in the other groups. LZD 2 mg/mL group had the lowest mean epithelial erosion values. CONCLUSIONS: Topical LZD showed activity against MRSA that was comparable to fortified VA in this experimental keratitis model.


Asunto(s)
Acetamidas/uso terapéutico , Antibacterianos/uso terapéutico , Úlcera de la Córnea/tratamiento farmacológico , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Oxazolidinonas/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/uso terapéutico , Administración Tópica , Animales , Carga Bacteriana , Recuento de Colonia Microbiana , Ensayo de Unidades Formadoras de Colonias , Úlcera de la Córnea/microbiología , Úlcera de la Córnea/patología , Modelos Animales de Enfermedad , Infecciones Bacterianas del Ojo/microbiología , Infecciones Bacterianas del Ojo/patología , Linezolid , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Soluciones Oftálmicas , Conejos , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/patología
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