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Öğe 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, HavaObjectives: 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.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, HavaThe 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.Öğe Efficacy of colistin and non-colistin monotherapies in multi-drug resistant acinetobacter baumannii bacteremia/sepsis(Acta Medica Mediterranea, 2014) Karabay, Oğuz; Batırel, Ayşe; Balkan, İlker İnanç; Ağalar, Canan; Akalın, Şerife; Alıcı, Özlem; Alp, Emine; Aybala Alta, Fatma; Altın, Nilgün; Arslan, Ferhat; Aslan, Turan; Bekiroğlu, Nural; Cesur, Salim; Doğan Çelik, Aygül; Doğan, Mustafa; Durdu, Bülent; Duygu, Fazilet; Engin, Aynur; Öztürk Engin, Derya; Gönen, İbak; Güçlü, Ertuğrul; Güven, Tümer; Ataman Hatipoğlu, Çiğdem; Hoşoğlu, Salih; Karahocagil, Mustafa; Ulu Kılıç, Ayşegül; Örmen, Bahar; Özdemir, Davut; Özer, Serdal; Öztoprak, Nefise; Sezak, Nurbanu; Turhan, Vedat; Türker, Nesrin; Yılmaz, HavaObjective: This retrospective study aimed to investigate the efficacies of colistin and non-colistin monotherapies in multi-drug resistant Acinetobacter baumannii bacteremia (MDR-AB). Materials and methods: Cases with MDR-AB from 27 tertiary-referral hospitals between January 2009 and December 2012 were included. Patients' data that were on either colistin monotherapy (CM) or non-colistin monotherapy (NCM) were compared. Mortality on Day 14 was the primary endpoint, whereas microbiological eradication and clinical outcome were the secondary ones. Results: Eighty-four cases were included in the study with 36 being in the CM group and 48 in the NCM group. Thirty-eight (45.2%) cases were male and the mean age was 60.2 years. The mean durations of pre-MDR-AB hospital stay and intensive care unit stay were 25.8 days and 20.9 days, respectively. All of the cases had fever (>38°C). The mean Pitt bacteremia score (PBS) of the patients was calculated as 6.8, APACHE 2 score as 18.9 and the Charlson co-morbidity index (CCI) as 3.7 (CM: 3.6 vs. NCM: 3.9). Twenty (55.6%) cases in the CM group and 26 cases in the NCM group (54.2%) (p=0.81) died; 9 cases in the CM group (25%) and 16 cases in the NCM group (33.3%) had treatment failure (P=0.55). Bacteriological eradication was achieved in 20 (55.6%) cases in the CM group and in 36 cases (75%) in the NCM group (P=0.061). Conclusions: No significant difference could be identified between the colistin monotherapy and non-colistin monotherapy options in MDR-AB cases with respect to the results of efficacy and 14-day mortality.Öğe N-acetylcysteine suppresses colistimethate sodium-induced nephrotoxicity via activation of SOD2, eNOS, and MMP3 protein expressions(Taylor & Francis Ltd., 2018) Ceylan, Bahadır; Ozansoy, Mehmet; Kılıç, Ülkan; Yozgat, Yasemin; Ercan, Çilem; Yıldız, Pelin; Aslan, TuranObjective: To investigate the molecular mechanisms of colistimethate sodium-induced nephrotoxicity and the protective effect of N-acetylcysteine (NAC) against nephrotoxicity.Methods: Twenty-eight Wistar rats were divided into four groups comprised of control, colistin, NAC, and colistin-NAC co-treatment, respectively. Serum creatinine and urine N-acetyl--d-glucosaminidase (NAG) levels were measured at different time intervals. Histological changes, apoptosis, total oxidant and antioxidant status, and the expression levels of endothelial nitric oxide synthase (eNOS), superoxide dismutase 2 (SOD2), and matrix metalloproteinase 3 (MMP3) were evaluated in renal tissue.Results: In the colistin group, post-treatment creatinine levels were higher than pretreatment levels (p=.001). There was a significant increase in urine NAG level following colistin treatment on day 10, compared to the baseline value and the first day of treatment (p=.001 and .0001, respectively). Urine NAG levels were higher in the colistin group on the 10th day of treatment than in the other groups (p<.01). Colistin treatment increased the apoptosis index and renal histological damage score (RHDS) significantly and these changes were reversed in NAC co-treatment (RHSD and apoptosis index were 45 and 0 for sterile saline group, 29 and 2 for NAC group, 122 and 7 for colistin group, and 66 and 2 for colistin+NAC group). We observed no difference between groups regarding total antioxidant and total oxidant status in the kidneys. The expression levels of eNOS, SOD2, and MMP3 decreased significantly in the kidneys of colistin-treated rats; these changes were reversed in the kidneys of NAC co-treated rats.Conclusions: N-acetylcysteine prevented colistin-induced nephrotoxicity through activation of expression levels of SOD2, eNOS, and MMP3.
