Multicenter Study of Clinical Features of Breakthrough Acinetobacter Bacteremia during Carbapenem Therapy
Breakthrough bacteremia during carbapenem therapy is not uncommon, and it creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough bacteremia during carbapenem therapy and to assess the efficacy of various anti...
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| Veröffentlicht in: | Antimicrobial agents and chemotherapy 2017-09, Vol.61 (9) |
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| container_title | Antimicrobial agents and chemotherapy |
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| creator | Lee, Yi-Tzu Wang, Yung-Chih Kuo, Shu-Chen Chen, Chung-Ting Liu, Chang-Pan Liu, Yuag-Meng Chen, Te-Li Yang, Ya-Sung |
| description | Breakthrough
bacteremia during carbapenem therapy is not uncommon, and it creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough
bacteremia during carbapenem therapy and to assess the efficacy of various antimicrobial therapies. We analyzed 100 adults who developed breakthrough
bacteremia during carbapenem therapy at 4 medical centers over a 6-year period. Their 30-day mortality rate was 57.0%, and the carbapenem resistance rate of their isolates was 87.0%. Among patients with carbapenem-resistant
bacteremia, breakthrough bacteremia during carbapenem therapy was associated with a significantly higher 14-day mortality (51.7% versus 37.4%, respectively;
= 0.025 by bivariate analysis) and a higher 30-day mortality (
= 0.037 by log rank test of survival analysis) than in the nonbreakthrough group. For the treatment of breakthrough
bacteremia during carbapenem therapy, tigecycline-based therapy was associated with a significantly higher 30-day mortality (80.0%) than those with continued carbapenem therapy (52.5%) and colistin-based therapy (57.9%) by survival analysis (
= 0.047 and 0.045 by log rank test, respectively). Cox regression controlling for confounders, including severity of illness indices, demonstrated that treatment with tigecycline-based therapy for breakthrough
bacteremia was an independent predictor of 30-day mortality (hazard ratio, 3.659; 95% confidence interval, 1.794 to 7.465;
< 0.001). Patients with breakthrough
bacteremia during carbapenem therapy posed a high mortality rate. Tigecycline should be used cautiously for the treatment of breakthrough
bacteremia that develops during carbapenem therapy. |
| doi_str_mv | 10.1128/AAC.00931-17 |
| format | Article |
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bacteremia during carbapenem therapy is not uncommon, and it creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough
bacteremia during carbapenem therapy and to assess the efficacy of various antimicrobial therapies. We analyzed 100 adults who developed breakthrough
bacteremia during carbapenem therapy at 4 medical centers over a 6-year period. Their 30-day mortality rate was 57.0%, and the carbapenem resistance rate of their isolates was 87.0%. Among patients with carbapenem-resistant
bacteremia, breakthrough bacteremia during carbapenem therapy was associated with a significantly higher 14-day mortality (51.7% versus 37.4%, respectively;
= 0.025 by bivariate analysis) and a higher 30-day mortality (
= 0.037 by log rank test of survival analysis) than in the nonbreakthrough group. For the treatment of breakthrough
bacteremia during carbapenem therapy, tigecycline-based therapy was associated with a significantly higher 30-day mortality (80.0%) than those with continued carbapenem therapy (52.5%) and colistin-based therapy (57.9%) by survival analysis (
= 0.047 and 0.045 by log rank test, respectively). Cox regression controlling for confounders, including severity of illness indices, demonstrated that treatment with tigecycline-based therapy for breakthrough
bacteremia was an independent predictor of 30-day mortality (hazard ratio, 3.659; 95% confidence interval, 1.794 to 7.465;
< 0.001). Patients with breakthrough
bacteremia during carbapenem therapy posed a high mortality rate. Tigecycline should be used cautiously for the treatment of breakthrough
bacteremia that develops during carbapenem therapy.</description><identifier>ISSN: 0066-4804</identifier><identifier>EISSN: 1098-6596</identifier><identifier>DOI: 10.1128/AAC.00931-17</identifier><identifier>PMID: 28674056</identifier><language>eng</language><publisher>United States: American Society for Microbiology</publisher><subject>Acinetobacter baumannii ; Acinetobacter baumannii - drug effects ; Acinetobacter baumannii - isolation & purification ; Acinetobacter Infections ; Acinetobacter Infections - drug therapy ; Acinetobacter Infections - microbiology ; Acinetobacter Infections - mortality ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; Anti-Bacterial Agents - therapeutic use ; Bacteremia ; Bacteremia - drug therapy ; Bacteremia - microbiology ; Bacteremia - mortality ; Carbapenems ; Carbapenems - therapeutic use ; Clinical Therapeutics ; Comorbidity ; Cross Infection - drug therapy ; Cross Infection - microbiology ; Cross Infection - mortality ; Drug Resistance, Multiple, Bacterial ; Female ; Humans ; Male ; Microbial Sensitivity Tests ; Middle Aged ; Treatment Outcome</subject><ispartof>Antimicrobial agents and chemotherapy, 2017-09, Vol.61 (9)</ispartof><rights>Copyright © 2017 American Society for Microbiology.</rights><rights>Copyright © 2017 American Society for Microbiology. 2017 American Society for Microbiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a418t-aca23d3e3e8b02d9eba26af704619979b4ad4040e9fa27c101f4fa61a9f4f8e93</citedby><cites>FETCH-LOGICAL-a418t-aca23d3e3e8b02d9eba26af704619979b4ad4040e9fa27c101f4fa61a9f4f8e93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571354/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571354/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28674056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Yi-Tzu</creatorcontrib><creatorcontrib>Wang, Yung-Chih</creatorcontrib><creatorcontrib>Kuo, Shu-Chen</creatorcontrib><creatorcontrib>Chen, Chung-Ting</creatorcontrib><creatorcontrib>Liu, Chang-Pan</creatorcontrib><creatorcontrib>Liu, Yuag-Meng</creatorcontrib><creatorcontrib>Chen, Te-Li</creatorcontrib><creatorcontrib>Yang, Ya-Sung</creatorcontrib><title>Multicenter Study of Clinical Features of Breakthrough Acinetobacter Bacteremia during Carbapenem Therapy</title><title>Antimicrobial agents and chemotherapy</title><addtitle>Antimicrob Agents Chemother</addtitle><addtitle>Antimicrob Agents Chemother</addtitle><description>Breakthrough
bacteremia during carbapenem therapy is not uncommon, and it creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough
bacteremia during carbapenem therapy and to assess the efficacy of various antimicrobial therapies. We analyzed 100 adults who developed breakthrough
bacteremia during carbapenem therapy at 4 medical centers over a 6-year period. Their 30-day mortality rate was 57.0%, and the carbapenem resistance rate of their isolates was 87.0%. Among patients with carbapenem-resistant
bacteremia, breakthrough bacteremia during carbapenem therapy was associated with a significantly higher 14-day mortality (51.7% versus 37.4%, respectively;
= 0.025 by bivariate analysis) and a higher 30-day mortality (
= 0.037 by log rank test of survival analysis) than in the nonbreakthrough group. For the treatment of breakthrough
bacteremia during carbapenem therapy, tigecycline-based therapy was associated with a significantly higher 30-day mortality (80.0%) than those with continued carbapenem therapy (52.5%) and colistin-based therapy (57.9%) by survival analysis (
= 0.047 and 0.045 by log rank test, respectively). Cox regression controlling for confounders, including severity of illness indices, demonstrated that treatment with tigecycline-based therapy for breakthrough
bacteremia was an independent predictor of 30-day mortality (hazard ratio, 3.659; 95% confidence interval, 1.794 to 7.465;
< 0.001). Patients with breakthrough
bacteremia during carbapenem therapy posed a high mortality rate. Tigecycline should be used cautiously for the treatment of breakthrough
bacteremia that develops during carbapenem therapy.</description><subject>Acinetobacter baumannii</subject><subject>Acinetobacter baumannii - drug effects</subject><subject>Acinetobacter baumannii - isolation & purification</subject><subject>Acinetobacter Infections</subject><subject>Acinetobacter Infections - drug therapy</subject><subject>Acinetobacter Infections - microbiology</subject><subject>Acinetobacter Infections - mortality</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anti-Bacterial Agents</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Bacteremia</subject><subject>Bacteremia - drug therapy</subject><subject>Bacteremia - microbiology</subject><subject>Bacteremia - mortality</subject><subject>Carbapenems</subject><subject>Carbapenems - therapeutic use</subject><subject>Clinical Therapeutics</subject><subject>Comorbidity</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - mortality</subject><subject>Drug Resistance, Multiple, Bacterial</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Microbial Sensitivity Tests</subject><subject>Middle Aged</subject><subject>Treatment Outcome</subject><issn>0066-4804</issn><issn>1098-6596</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUFv1DAQha0K1G4Lt55RjiCRMk4cx74gbSPaIhVxoJytSTLZdUnixY6R9t-TdNuqHDg92fP5jZ4fY-ccLjjP1Kf1uroA0DlPeXnEVhy0SmWh5Su2ApAyFQrECTsN4R7mc6HhmJ1kSpYCCrli9lvsJ9vQOJFPfkyx3SeuS6rejrbBPrkinKKnsFxeesJf09a7uNkm68aONLkam-Xh5YPQYDFpo7fjJqnQ17ijkYbkbksed_s37HWHfaC3j3rGfl59uatu0tvv11-r9W2KgqspxQazvM0pJ1VD1mqqMZPYlSAk17rUtcBWgADSHWZlw4F3okPJUc-qSOdn7PPBdxfrgdolmsfe7Lwd0O-NQ2v-nYx2azbujymKkueFmA3ePxp49ztSmMxgQ0N9jyO5GAzXvFAKSr2gHw9o410InrrnNRzM0o6Z2zEP7RhezviHA45hyMy9i36cf-J_7LuXMZ6Nn6rL_wL9PpnH</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Lee, Yi-Tzu</creator><creator>Wang, Yung-Chih</creator><creator>Kuo, Shu-Chen</creator><creator>Chen, Chung-Ting</creator><creator>Liu, Chang-Pan</creator><creator>Liu, Yuag-Meng</creator><creator>Chen, Te-Li</creator><creator>Yang, Ya-Sung</creator><general>American Society for Microbiology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170901</creationdate><title>Multicenter Study of Clinical Features of Breakthrough Acinetobacter Bacteremia during Carbapenem Therapy</title><author>Lee, Yi-Tzu ; Wang, Yung-Chih ; Kuo, Shu-Chen ; Chen, Chung-Ting ; Liu, Chang-Pan ; Liu, Yuag-Meng ; Chen, Te-Li ; Yang, Ya-Sung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a418t-aca23d3e3e8b02d9eba26af704619979b4ad4040e9fa27c101f4fa61a9f4f8e93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acinetobacter baumannii</topic><topic>Acinetobacter baumannii - drug effects</topic><topic>Acinetobacter baumannii - isolation & purification</topic><topic>Acinetobacter Infections</topic><topic>Acinetobacter Infections - drug therapy</topic><topic>Acinetobacter Infections - microbiology</topic><topic>Acinetobacter Infections - mortality</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anti-Bacterial Agents</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Bacteremia</topic><topic>Bacteremia - drug therapy</topic><topic>Bacteremia - microbiology</topic><topic>Bacteremia - mortality</topic><topic>Carbapenems</topic><topic>Carbapenems - therapeutic use</topic><topic>Clinical Therapeutics</topic><topic>Comorbidity</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - mortality</topic><topic>Drug Resistance, Multiple, Bacterial</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Microbial Sensitivity Tests</topic><topic>Middle Aged</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Yi-Tzu</creatorcontrib><creatorcontrib>Wang, Yung-Chih</creatorcontrib><creatorcontrib>Kuo, Shu-Chen</creatorcontrib><creatorcontrib>Chen, Chung-Ting</creatorcontrib><creatorcontrib>Liu, Chang-Pan</creatorcontrib><creatorcontrib>Liu, Yuag-Meng</creatorcontrib><creatorcontrib>Chen, Te-Li</creatorcontrib><creatorcontrib>Yang, Ya-Sung</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Antimicrobial agents and chemotherapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Yi-Tzu</au><au>Wang, Yung-Chih</au><au>Kuo, Shu-Chen</au><au>Chen, Chung-Ting</au><au>Liu, Chang-Pan</au><au>Liu, Yuag-Meng</au><au>Chen, Te-Li</au><au>Yang, Ya-Sung</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multicenter Study of Clinical Features of Breakthrough Acinetobacter Bacteremia during Carbapenem Therapy</atitle><jtitle>Antimicrobial agents and chemotherapy</jtitle><stitle>Antimicrob Agents Chemother</stitle><addtitle>Antimicrob Agents Chemother</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>61</volume><issue>9</issue><issn>0066-4804</issn><eissn>1098-6596</eissn><abstract>Breakthrough
bacteremia during carbapenem therapy is not uncommon, and it creates therapeutic dilemmas for clinicians. This study was conducted to evaluate the clinical and microbiological characteristics of breakthrough
bacteremia during carbapenem therapy and to assess the efficacy of various antimicrobial therapies. We analyzed 100 adults who developed breakthrough
bacteremia during carbapenem therapy at 4 medical centers over a 6-year period. Their 30-day mortality rate was 57.0%, and the carbapenem resistance rate of their isolates was 87.0%. Among patients with carbapenem-resistant
bacteremia, breakthrough bacteremia during carbapenem therapy was associated with a significantly higher 14-day mortality (51.7% versus 37.4%, respectively;
= 0.025 by bivariate analysis) and a higher 30-day mortality (
= 0.037 by log rank test of survival analysis) than in the nonbreakthrough group. For the treatment of breakthrough
bacteremia during carbapenem therapy, tigecycline-based therapy was associated with a significantly higher 30-day mortality (80.0%) than those with continued carbapenem therapy (52.5%) and colistin-based therapy (57.9%) by survival analysis (
= 0.047 and 0.045 by log rank test, respectively). Cox regression controlling for confounders, including severity of illness indices, demonstrated that treatment with tigecycline-based therapy for breakthrough
bacteremia was an independent predictor of 30-day mortality (hazard ratio, 3.659; 95% confidence interval, 1.794 to 7.465;
< 0.001). Patients with breakthrough
bacteremia during carbapenem therapy posed a high mortality rate. Tigecycline should be used cautiously for the treatment of breakthrough
bacteremia that develops during carbapenem therapy.</abstract><cop>United States</cop><pub>American Society for Microbiology</pub><pmid>28674056</pmid><doi>10.1128/AAC.00931-17</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Acinetobacter baumannii Acinetobacter baumannii - drug effects Acinetobacter baumannii - isolation & purification Acinetobacter Infections Acinetobacter Infections - drug therapy Acinetobacter Infections - microbiology Acinetobacter Infections - mortality Aged Aged, 80 and over Anti-Bacterial Agents Anti-Bacterial Agents - therapeutic use Bacteremia Bacteremia - drug therapy Bacteremia - microbiology Bacteremia - mortality Carbapenems Carbapenems - therapeutic use Clinical Therapeutics Comorbidity Cross Infection - drug therapy Cross Infection - microbiology Cross Infection - mortality Drug Resistance, Multiple, Bacterial Female Humans Male Microbial Sensitivity Tests Middle Aged Treatment Outcome |
| title | Multicenter Study of Clinical Features of Breakthrough Acinetobacter Bacteremia during Carbapenem Therapy |
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