Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections
Rifampicin/imipenem combination in the treatment of carbapenem-resistant Acinetobacter baumannii infections
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DOI：
10.1093/jac/dkl274
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发表时间：
2006-09-01
影响因子：
5.2
通讯作者：
Ariza, Javier
中科院分区：
文献类型：
--
作者：
Saballs, Mireia;Pujol, Miquel;Ariza, Javier
背景：在鲍曼不动杆菌感染大规模流行的背景下，对仅对粘菌素敏感的碳青霉烯耐药菌株的治疗已成为该院近年来的一大难题。据报道，使用粘菌素取得了成功的结果，但这种抗生素的临床经验有限。在我们使用这些菌株进行的小鼠肺炎模型的实验研究中，利福平和亚胺培南的联合应用效果最好。方法：从2000年7月到2001年9月，我们对耐碳青霉烯的鲍曼不动杆菌严重感染患者进行了初步研究。患者接受利福平/亚胺培南联合治疗，并进行前瞻性随访。在治疗期间和治疗后重复培养，并监测利福平的体外活性。结果：10例患者中4例为呼吸机相关性肺炎，6例为其他感染(1例导管相关菌血症，5例外科感染)。三名患者死亡，其中两名被认为是治疗失败。在治愈的7名患者中，有5名还接受了其他手术，如手术引流或拔除导管。7例(70%)在体外产生了对利福平的高耐药性。结论：我们的研究结果反对将利福平/亚胺培南联合用于治疗碳青霉烯耐药鲍曼不动杆菌感染。然而，利福平与其他抗生素的组合值得进一步研究。
Background: In the setting of a large endemic of Acinetobacter baumannii infections, treatment of those due to carbapenem-resistant strains, susceptible only to colistin, has become a major problem in our hospital during the past years. Successful results have been reported using colistin, but clinical experience with this antibiotic is limited. In our experimental studies using these strains in a mouse pneumonia model, the best results were observed with a combination of rifampicin and imipenem.Methods: From July 2000 to September 2001, we performed a pilot study with patients suffering from serious infections due to carbapenem-resistant A. baumannii. Patients were treated with a rifampicin/imipenem combination and followed up prospectively. Cultures were repeated during and after treatment, and in vitro activity of rifampicin was monitored. Genotyping of these strains was performed by means of PFGE.Results: Ten patients were selected: four with ventilator-associated pneumonia, and six with other infections (one catheter-related bacteraemia, five surgical infections). Three patients died, two of whom were considered therapeutic failures. In five of the seven patients who were cured, other procedures were also performed such as surgical drainage or catheter removal. In vitro development of high resistance to rifampicin was shown in seven (70%). PFGE demonstrated that initial isolates and high-resistant strains belonged to the same clones.Conclusions: The results of our study argue against the use of a rifampicin/imipenem combination for the treatment of carbapenem-resistant A. baumannii infections. However, combinations of rifampicin with other antibiotics merit further studies.