Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections
复制标题
DOI：
10.1007/s10096-014-2070-6
复制
发表时间：
2014-08-01
影响因子：
4.5
通讯作者：
Yilmaz, H.
中科院分区：
文献类型：
--
作者：
Batirel, A.;Balkan, I. I.;Yilmaz, H.
这项研究的目的是比较粘菌素为基础的疗法在极端耐药不动杆菌属中的疗效。血液感染(XDR-ABSI)。从2009年1月到2012年8月，在27个三级护理中心进行了一项回顾性研究。主要终点是14天的存活期，次要终点是临床和微生物结果。36 2 14例患者[粘菌素-碳青霉烯(CC)10 2例(47.7%)，粘菌素-舒巴坦(CS)69例(32.2%)，粘菌素联合其他药物(CO)43例(2 0.1%)]分别接受粘菌素单一治疗和粘菌素联合治疗。联合组的完全缓解/治愈率和14天存活率相对较高，微生物清除率明显较高。此外，联合用药组的住院死亡率也明显较低。在临床(p=0.97)、微生物学(p=0.92)结果和14天存活率(p=0.79)方面，三种联合用药组之间没有显著差异。在三组患者中，初始有效治疗的时间和是否存在任何合并感染并不显著(p>；0.05)，对14天的存活期也没有显著影响(p>；0.05)。较高的PITT菌血症评分、急性生理学和慢性健康评估II评分、Charlson共病指数以及在XDR-ABSI前住院和重症监护病房的时间延长是导致14天死亡率的显著危险因素(分别为p=0.02、p=0.0001、p=0.0001、p=0.02和p=0.01)。在多变量分析中，PBS、年龄和ICU住院时间是14天死亡率的独立危险因素(p<；0.0001，p<；0.0001，p=0.001)。与粘菌素单一疗法相比，基于粘菌素的联合疗法显著提高了微生物清除率，相对较高的治愈率和14天存活率，以及较低的住院死亡率。CC、CS和CO联合治疗XDR-ABSI在倾向评分匹配(PSM)前后的14天存活率和临床或微生物学结果方面没有显著差异。PBS、年龄和ICU住院时间是14天死亡率的独立危险因素。
The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7 %): colistin-carbapenem (CC), 69 (32.2 %): colistin-sulbactam (CS), and 43 (20.1 %: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.