Colistin is effective in treatment of infections caused by multidrug-resistant Pseudomonas aeruginosa in cancer patients
Colistin is effective in treatment of infections caused by multidrug-resistant Pseudomonas aeruginosa in cancer patients
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DOI：
10.1128/aac.01015-06
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发表时间：
2007-06-01
影响因子：
4.9
通讯作者：
Raad, Issam I.
中科院分区：
文献类型：
--
作者：
Hachem, Ray Y.;Chemaly, Roy F.;Raad, Issam I.
由多重耐药铜绿假单胞菌引起的感染的发病率不断增加是一个世界性的健康问题。由于在不久的将来没有新的抗假单胞菌药物，我们评估了粘菌素的安全性和有效性，粘菌素是一种对这种微生物具有杀菌活性的老药。我们收集了2001年1月至2004年1月期间95例诊断为多重耐药铜绿假单胞菌感染的癌症患者的临床和人口统计学数据，这些患者接受了粘菌素（粘菌素组）或至少一种活性抗假单胞菌药物（β-内酰胺类抗生素或喹诺酮类）（对照组）治疗。我们比较了两组的结果。31例患者接受了粘菌素治疗，64例患者接受了不含粘菌素的抗假单胞菌治疗方案。与对照组相比，粘菌素组患者的中位年龄较低（分别为52岁和62岁; P = 0.012），但更容易发生医院感染（分别为87%和64%; P = 0.02）。粘菌素组25例患者（81%）和对照组40例患者（63%）的APACHE II评分> 15（P = 0.074）。多粘菌素组和对照组的总体临床应答率分别为52%和31%（P = 0.055）。多因素logistic回归分析显示，与对照组相比，接受粘菌素治疗的患者发生临床反应的可能性高2.9倍（95%置信区间，1.1 - 7.6倍）（P = 0.026）。多粘菌素治疗在治疗多重耐药铜绿假单胞菌引起的感染中至少与β-内酰胺抗生素或喹诺酮一样有效和安全，因此可能是癌症患者中这种感染的有用或优选的替代疗法。
The increasing incidence of infections caused by multidrug-resistant Pseudomonas aeruginosa is a worldwide health problem. Because no new antipseudomonal agents are expected to be available in the near future, we evaluated the safety and efficacy of colistin, an old drug with bactericidal activity against this organism. We collected clinical and demographic data on 95 cancer patients diagnosed with infections caused by multidrug-resistant P. aeruginosa between January 2001 and January 2004 and treated with either colistin (colistin group) or at least one active antipseudomonal agent (a beta-lactam antibiotic or a quinolone) (control group). We compared the results obtained for both groups. Thirty-one patients had been treated with colistin and 64 had been treated with an antipseudomonal non-colistin-containing regimen. Compared with the control group, patients in the colistin group had a lower median age (52 and 62 years, respectively; P = 0.012) but were more likely to have had nosocomial infections (87% and 64%, respectively; P = 0.02). Twenty-five patients (81%) in the colistin group and 40 patients (63%) in the control group had an APACHE II score of > 15 (P = 0.074). The overall clinical response rates were 52% in the colistin group and 31% in the control group (P = 0.055). Multiple logistic regression analysis showed that those patients treated with colistin were 2.9 times (95% confidence interval, 1.1 to 7.6 times) more likely than those in the control group to experience a clinical response to therapy (P = 0.026). Colistin therapy was at least as effective and as safe a beta-lactam antibiotic or a quinolone in the treatment of infections caused by multidrug-resistant P. aeruginosa and, hence, may be a useful or preferred alternative therapy for this infection in cancer patients.