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Identifier

000400078

Title

Συχνότητα έκβαση και παράγοντες κινδύνου για λοιμώξεις από ανθεκτικούς στην κολιστίνη Gram αρνητικούς μικροοργανισμούς

Alternative Title

Incidence outcome and risk factors for infections due to colistin -resistant gram negative microorganisms

Author

Ματθαίου, Δημήτριος Κ.

Thesis advisor

Σαμώνης, Γεώργιος
Γκίκας, Αχιλλέας
Γεωργόπουλος, Δημήτριος

Reviewer

Κοφτερίδης, Διαμαντής
Γαλανάκης, Εμμανουήλ
Μαυρουδής, Δημήτριος
Γανωτάκης, Εμμανουήλ

Abstract

Polymyxins, although they belong to an old antibiotic class and were widely used, they were abandoned in the mid-80’s due to side effects. They re-emerged as a treatment option for infections due to gram-negative pathogens after the emergence of multidrugresistant pathogens. Ιt is systematically administered in the form of colistin methanosulphate and it is hydrolyzed to colistin and other molecules. Its pharmacokinetics are not well-understood, and a matter that may cause confusion regards the measurement units used for its administration. Recent studies suggest the administration of a loading dose and a total daily dose of more than 6 million IU to critically ill patients with preserved renal function. Resistance to polymyxins varies. The most cumulative reports come from SENTRY program, which monitors the resistance patterns of various pathogens that are collected worldwide. The most important mechanism of resistance to polymyxins included modifications of the outer bacterial membrane, mainly through the modification of lipopolysaccharite. Further modifications of the outer bacterial membrane, may confer to the emergence of resistance to polymyxins. Another mechanism includes the development of an potassium-efflux pump. Data regarding patients infected by pandrug-resistant P. aeruginosa, K. pneumoniae and 17 A. Baumannii are scarce. In order to successfully combat such infections, combination antibiotic therapy seems to be the most effective. Combination therapy with regimens including polymyxins along with other antibiotics may pose a useful alternative in treating infections due to polymyxin-resistant gram-negative pathogens. We analyzed resistance patterns of strains belonging to P. aeruginosa, K. pneumoniae and Acinetobacter species, which were isolated from patients hospitalized in Herakleion University Hospital. This analysis showed that a significant portion of colistin-resistant gram-negative bacterial strains (mainly K. pneumoniae) isolated from patients of this particular hospital maintained sensitivity to several other antimicrobial agents. We described characteristics and outcomes of infections due to pandrug-resistant gramnegative bacteria in patients hospitalized in a tertiary hospital. Overall in-hospital mortality was 41.7%, while attributable-mortality was 33.3%. Infection-related mortality due to pan-drug gram-negative bacteria is not as high as expected given that the studied strains were resistant to all available antibiotics. Antibiotics that are not active in vitro may prove lifesaving for some of these patients, especially in combination regimens including colistin. We conducted a matched case-control study to investigate potential risk factors for the isolation of colistin-resistant Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa from hospitalized patients in a tertiary hospital in Athens, Greece. Risk factors that were significantly associated with the isolation of colistin18 resistant isolates were age, duration of ICU stay, surgical procedures, use of colistin, use of monobactams, duration of colistin use, and duration of antifungal agent use. Colistin use was identified as the only independent risk factor.

Language

Greek

Subject

Acinetobacter

Polymyxins

Πολυμυξίνες

Ψευδομονάδα

Issue date

2016-03-24

Collection

School/Department--School of Medicine--Department of Medicine--Doctoral theses

Type of Work--Doctoral theses