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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
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Ματθαίου, Δημήτριος Κ.
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Thesis advisor
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Σαμώνης, Γεώργιος
Γκίκας, Αχιλλέας
Γεωργόπουλος, Δημήτριος
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Reviewer
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Κοφτερίδης, Διαμαντής
Γαλανάκης, Εμμανουήλ
Μαυρουδής, Δημήτριος
Γανωτάκης, Εμμανουήλ
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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
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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.
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Language |
Greek |
Subject |
Acinetobacter |
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Polymyxins |
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Πολυμυξίνες |
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Ψευδομονάδα |
Issue date |
2016-03-24 |
Collection
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School/Department--School of Medicine--Department of Medicine--Doctoral theses
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Type of Work--Doctoral theses
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Permanent Link |
https://elocus.lib.uoc.gr//dlib/b/e/1/metadata-dlib-1459320730-448607-27147.tkl
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Views |
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