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  • Küçük Resim
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    Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: A Multicenter retrospective analysis
    (Medknow Publications, 2015) İnanç Balkan, İlker; Batırel, Ayşe; Karabay, Oğuz; A?alar, Canan; Akalın, Şerife; Alıcı, Özlem; Alp, Emine; Altay, Fatma Aybala; Altın, Nilgün; Arslan, Ferhat; Aslan, Turan; Bekiroğlu, Nural; Cesur, Salih; Do?an Çelik, Aygül; Do?an, Mustafa; Durdu, Bülent; Duygu, Fazilet; Engin, Aynur; Öztürk Engin, Derya; Gönen, İbak; Güçlü, Ertuğrul; Güven, Tümer; Hatipo?lu, Çi?dem; Hoşo?lu, Salih; Karahocagil, Mustafa Kasım; Ulu Kılıç, Ayşegül; Örmen, Bahar; Özdemir, Davut; Özer, Serdar; Öztoprak, Nefise; Sezak, Nur Banu; Turhan, Vedat; Türker, Nesrin; Yılmaz, Hava
    Objectives: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A) . Materials and Methods: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. Primary End-Point: 14-day mortality. Secondary End-Points: Microbial eradication and clinical improvement. Results: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. Conclusion: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.
  • Küçük Resim
    Öğe
    Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
    (Springer, 2014) Batirel, Ayşe; Balkan, İlker İnanç; Karabay, Oğuz; Ağalar, Canan; Akalın, Şerife; Alıcı, Özlem; Alp, Emine; Altay, Fatma Aybala; Altın, Nilgün; Arslan, Ferhat; Aslan, Turan; Bekiroğlu, Nuray; Cesur, Salim; Çelik, Aygül Dogan; Doğan, Mustafa; Durdu, Bülent; Duygu, Fazilet; Engin, Aynur; Engin, Derya Öztürk; Gönen, İbak; Güçlü, Ertuğrul; Güven, Tümer; Hatipoğlu, Çiğdem Ataman; Hoşoğlu, Salih; Karahocagil, Mustafa Kasım; Ulu Kılıç, Aysegül; Örmen, Bahar; Özdemir, Davut; Özer, Serdar; Öztoprak, Nefise; Sezak, Nurbanu; Turhan, Vedat; Türker, Nesrin; Yılmaz, Hava
    The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7 %): colistin-carbapenem (CC), 69 (32.2 %): colistin-sulbactam (CS), and 43 (20.1 %: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.