Treatment of extensively-drug resistant (XDR) Acinetobacter and impact on clinical outcomes in U.S. veterans affairs (VA) medical centers.
Treatment of extensively-drug resistant (XDR) Acinetobacter and impact on clinical outcomes in U.S. veterans affairs (VA) medical centers.
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DOI：
10.1016/j.ajic.2022.01.011
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发表时间：
2022-09
影响因子：
4.9
通讯作者：
中科院分区：
文献类型：
--
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耐药革兰氏阴性感染的治疗指南不包括鲍曼不动杆菌（AB），在最佳治疗实践方面留下了知识空白。本研究描述了广泛耐药（XDR） AB的治疗方法和结果。回顾性队列研究包括2012-2018年在退伍军人事务医疗中心接受XDRAB（除2个或更少类别外对至少1种药物不敏感）和抗生素治疗的患者。描述性统计概述抗生素；采用倾向得分校正回归模型比较结果。276例患者接受439例XDRAB培养和革兰氏阴性靶向抗生素治疗。118例（43%）患者接受单一治疗，158例（57%）患者接受联合治疗，最常见的包括碳青霉烯类（106例，67%）和多粘菌素（66例，42%）。184例（67%）患者接受的治疗不充分。在调整后的模型中，联合治疗并没有降低住院死亡率（aOR 1.24, 95%CI 0.60-2.59）或30天死亡率（aOR 1.43, 95%CI 0.86-2.38），或培养后住院时间中位数（aIRR 1.11, 95%CI 0.86-1.43）。同样，接受不充分的治疗与较差的结果无关。在这个全国性的XDRAB患者队列中，联合治疗和接受适当的治疗都没有改善结果。需要进一步研究这种难以治疗的病原体的最佳管理，有效的抗生素选择很少。
Guidelines for treatment of resistant Gram-negative infections do not include Acinetobacter baumannii (AB), leaving a knowledge gap in best practices for treatment. This study described treatments and outcomes of extensively-drug resistant (XDR) AB. Retrospective cohort study including patients with XDRAB (non-susceptible to at least 1 agent in all but 2 or fewer classes) and antibiotic treatment between 2012–2018 at Veterans Affairs Medical Centers. Descriptive statistics summarized antibiotics; propensity score adjusted regression models were fit to compare outcomes. 276 patients with 439 XDRAB cultures and Gram-negative targeted antibiotic treatment were included. 118 (43%) patients received monotherapy while 158 (57%) received combination therapy, most commonly including a carbapenem (n=106, 67%) and polymyxin (n=66, 42%). 184 (67%) patients received inadequate treatment. In adjusted models, combination therapy did not decrease the odds of in-hospital (aOR 1.24, 95%CI 0.60–2.59) or 30-day (aOR 1.43, 95%CI 0.86–2.38) mortality, or median post-culture length of stay (aIRR 1.11, 95%CI 0.86–1.43). Likewise, receipt of inadequate treatment was not associated with poorer outcomes. In this national cohort of patients with XDRAB, neither combination therapy nor receipt of adequate treatment improved outcomes. Further research is needed on optimal management of this difficult-to-treat pathogen with few effective antibiotic options.
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