Colistin and Rifampicin Compared With Colistin Alone for the Treatment of Serious Infections Due to Extensively Drug-Resistant Acinetobacter baumannii: A Multicenter, Randomized Clinical Trial
| Autor: | Maria De Cristoforo, Matteo Bassetti, Raffaele Zarrilli, Annunziata Mattei, Emanuele Durante-Mangoni, Giuseppe Signoriello, Claudio Viscoli, Nicola Galdieri, Antonio Corcione, Roberto Andini, Nicola Petrosillo, Paolo Malacarne, Paola Elvira Mocavero, Riccardo Utili, Patrizia Murino, Ciro Gallo |
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| Přispěvatelé: | DURANTE MANGONI, Emanuele, Signoriello, Giuseppe, Andini, R, Mattei, A, De Cristoforo, M, Murino, P, Bassetti, M, Malacarne, P, Petrosillo, N, Galdieri, N, Mocavero, P, Corcione, A, Viscoli, C, Zarrilli, R, Gallo, Ciro, Utili, Riccardo, Durante Mangoni, E, Signoriello, G, De Cristofaro, Mg, Zarrilli, Raffaele, Gallo, C, Utili, R. |
| Rok vydání: | 2013 |
| Předmět: |
Acinetobacter baumannii
Male Drug Resistance Drug resistance Antimicrobial therapy law.invention Tertiary Care Centers Randomized controlled trial law Drug Resistance Multiple Bacterial 80 and over polycyclic compounds Aged 80 and over biology Bacterial Ventilator-associated pneumonia Middle Aged Intensive care unit Anti-Bacterial Agents Intensive Care Units Treatment Outcome Infectious Diseases Combination Drug Therapy Combination Female Rifampin Multiple Mortality Treatment efficacy Treatment safety Acinetobacter Infections Adult Aged Colistin Critical Illness Humans Length of Stay Survival Analysis Microbiology (medical) medicine.drug medicine.medical_specialty Drug Therapy Internal medicine Intensive care medicine business.industry biochemical phenomena metabolism and nutrition bacterial infections and mycoses biology.organism_classification medicine.disease Surgery mortality ventilator-associated pneumonia antimicrobial therapy treatment efficacy treatment safety bacteria business Rifampicin |
| Zdroj: | Clinical Infectious Diseases. 57:349-358 |
| ISSN: | 1537-6591 1058-4838 |
| Popis: | Background Extensively drug-resistant (XDR) Acinetobacter baumannii may cause serious infections in critically ill patients. Colistin often remains the only therapeutic option. Addition of rifampicin to colistin may be synergistic in vitro. In this study, we assessed whether the combination of colistin and rifampicin reduced the mortality of XDR A. baumannii infections compared to colistin alone. Methods This multicenter, parallel, randomized, open-label clinical trial enrolled 210 patients with life-threatening infections due to XDR A. baumannii from intensive care units of 5 tertiary care hospitals. Patients were randomly allocated (1:1) to either colistin alone, 2 MU every 8 hours intravenously, or colistin (as above), plus rifampicin 600 mg every 12 hours intravenously. The primary end point was overall 30-day mortality. Secondary end points were infection-related death, microbiologic eradication, and hospitalization length. Results Death within 30 days from randomization occurred in 90 (43%) subjects, without difference between treatment arms (P = .95). This was confirmed by multivariable analysis (odds ratio, 0.88 [95% confidence interval, .46-1.69], P = .71). A significant increase of microbiologic eradication rate was observed in the colistin plus rifampicin arm (P = .034). No difference was observed for infection-related death and length of hospitalization. Conclusions In serious XDR A. baumannii infections, 30-day mortality is not reduced by addition of rifampicin to colistin. These results indicate that, at present, rifampicin should not be routinely combined with colistin in clinical practice. The increased rate of A. baumannii eradication with combination treatment could still imply a clinical benefit. Clinical trials registration NCT01577862. |
| Databáze: | OpenAIRE |
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