Treatment of Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia: Retrospective Comparison Between Intravenous Colistin and Intravenous Ampicillin–Sulbactam
Treatment of Carbapenem-Resistant Acinetobacter baumannii Ventilator-Associated Pneumonia: Retrospective Comparison Between Intravenous Colistin and Intravenous Ampicillin–Sulbactam
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DOI：
10.1097/mjt.0b013e3182a32df3
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发表时间：
2016-01
影响因子：
4.2
通讯作者：
R. Zalts;A. Neuberger;K. Hussein;A. Raz-Pasteur;Y. Geffen;T. Mashiach;R. Finkelstein
中科院分区：
文献类型：
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作者：
R. Zalts;A. Neuberger;K. Hussein;A. Raz-Pasteur;Y. Geffen;T. Mashiach;R. Finkelstein
碳青霉烯类耐药鲍曼不动杆菌是重症监护病房呼吸机相关性肺炎（VAP）的主要致病菌。然而，没有足够的数据来指导这种感染的适当治疗。我们的目的是比较碳青霉烯类耐药A。用粘菌素或氨苄西林-舒巴坦治疗鲍曼不动杆菌VAP。我们对诊断为碳青霉烯类耐药的A。2008年和2009年期间，比较多粘菌素与氨苄西林-舒巴坦治疗患者的临床和微生物学治愈率、30天死亡率和肾功能变化。治疗和死亡率之间的关系通过多变量logistic回归分析进行了研究。在98例诊断为碳青霉烯类耐药的A.鲍曼不动型VAP组66例用粘菌素治疗，32例用氨苄西林-舒巴坦治疗。患者的基线特征相似，但接受粘菌素治疗的患者在VAP诊断前的重症监护室停留时间较长，肌酐清除率较低。两组的临床治愈率相似。在粘菌素组中，第7天的微生物学失败率更高[16/33（48%）vs. 3/17（18%; P = 0.03];患者的肌酐升高更显著（+0.2 ± 1.0 mg/dL vs. −0.3 ± 1.1 mg/dL; P = 0.021），治疗与30天死亡率增加相关（调整比值比，6.5; 95%置信区间，1.348-31.342; P = 0.02）。总之，接受粘菌素或氨苄西林-舒巴坦治疗的患者具有相似的临床治愈率。然而，粘菌素与更高的微生物学衰竭率、肾功能下降和30天死亡率增加有关。一项比较大剂量粘菌素和氨苄西林-舒巴坦治疗碳青霉烯类耐药曲霉菌的前瞻性研究鲍曼不动杆菌VAP是必要的。
Carbapenem-resistant Acinetobacter baumannii has been increasingly reported as the causative agent of ventilator-associated pneumonia (VAP) among patients in the intensive care units. However, there are insufficient data to guide the appropriate treatment for such infection. Our aim was to compare the outcome of carbapenem-resistant A. baumannii VAP treated with colistin or with ampicillin–sulbactam. We conducted a retrospective study of patients diagnosed with carbapenem-resistant A. baumannii VAP during 2008 and 2009. Clinical and microbiologic cure rates, 30-day mortality, and change in renal function were compared between patients treated with colistin versus those treated with ampicillin–sulbactam. The association between treatment and mortality was examined through multivariable logistic regression analysis. Of the 98 patients diagnosed with carbapenem-resistant A. baumannii VAP, 66 were treated with colistin and 32 with ampicillin–sulbactam. Baseline characteristics of patients were similar, except for a longer intensive care unit stay and lower creatinine clearance test before VAP diagnosis among patients treated with colistin. Clinical cure rates were similar in the 2 groups. In the colistin group, microbiologic failure rates were higher at 7 days [16/33 (48%) vs. 3/17 (18%); P = 0.03]; patients had a more significant elevation in creatinine (+0.2 ± 1.0 mg/dL vs. −0.3 ± 1.1 mg/dL; P = 0.021), and treatment was associated with an increased 30-day mortality (adjusted-odds ratio, 6.5; 95% confidence interval, 1.348–31.342; P = 0.02). In conclusion, patients treated with colistin or ampicillin–sulbactam had similar clinical cure rates. However, colistin was associated with higher rates of microbiologic failure, reduction in renal function, and an increased 30-day mortality. A prospective study comparing high-dose colistin and ampicillin–sulbactam for the treatment of carbapenem-resistant A. baumannii VAP is warranted.