J Korean Med Sci.
2019 Oct;34(39):e256. 10.3346/jkms.2019.34.e256.
Early Intravenous Colistin Therapy as a Favorable Prognostic Factor for 28-day Mortality in Patients with CRAB Bacteremia: a Multicenter Propensity Score-Matching Analysis
- Affiliations
-
- 1Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
- 2Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea.
- 3Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
- 4Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
- 5Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea. shegets@schmc.ac.kr
- KMID: 2459425
- DOI: http://doi.org/10.3346/jkms.2019.34.e256
Abstract
- BACKGROUND
Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with high mortality. One of the strategies to reduce the mortality in patients with CRAB infections is to use intravenous colistin early but the effect of this strategy has not been proven. Therefore, we investigated the association of early colistin therapy with 28-day mortality in patients with CRAB bacteremia.
METHODS
This retrospective multicenter propensity score-matching analysis was conducted in the Korea by reviewing the medical records of adult patients with CRAB bacteremia between January 2012 and March 2015. Early colistin therapy was defined as intravenous colistin administration for > 48 hours within five days after the blood culture collection. To identify the risk factors associated with the 28-day mortality in CRAB bacteremia, the clinical variables of the surviving patients were compared to those of the deceased patients.
RESULTS
Of 303 enrolled patients, seventy-six (25.1%) patients received early colistin therapy. The 28-day mortality was 61.4% (186/303). Fatal or rapidly-fatal McCabe classifications, intensive care unit admission, Sequential Organ Failure Assessment scores ≥ 8, vasopressor use, and acute kidney injury were statistically independent poor prognostic factors. Catheter-related infection and early colistin therapy (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.21-0.94) were independent favorable prognostic factors associated with 28-day mortality in patients with CRAB bacteremia. Early colistin therapy was still significantly associated with lower 28-day mortality in the propensity score-matching analysis (aOR, 0.31; 95% CI, 0.11-0.88).
CONCLUSION
This study suggests that early colistin therapy might help reduce the mortality of patients with CRAB bacteremia.
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