Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin:: A comparison with imipenem-susceptible VAP
Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin:: A comparison with imipenem-susceptible VAP
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DOI：
10.1086/374337
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发表时间：
2003-05-01
影响因子：
11.8
通讯作者：
Madrazo-Osuna, J
中科院分区：
文献类型：
--
作者：
Garnacho-Montero, J;Ortiz-Leyba, C;Madrazo-Osuna, J
我们前瞻性评估了静脉注射粘菌素治疗 35 例由多重耐药鲍曼不动杆菌引起的呼吸机相关性肺炎 (VAP) 的疗效和毒性。使用定量培养进行微生物学诊断。 21 名患者的发作是由仅对粘菌素敏感的菌株（CO 组）引起的，并且全部接受了静脉注射这种抗菌药物的治疗。 14 名患者的发作是由对亚胺培南仍然敏感的菌株引起的，并接受了亚胺培南-西司他丁治疗（IM 组）。两组入院时的急性生理学和慢性健康评估 II 评分以及诊断时的序贯器官衰竭评估评分相似。两组中 57% 的 VAP 被认为临床治愈。 CO 组和 IM 组的院内死亡率分别为 61.9% 和 64.2%，VAP 相关死亡率分别为 38% 和 35.7%。 CO 组有 4 名患者和 IM 组有 6 名患者出现肾衰竭。在 CO 组的 12 次发作期间进行了神经生理学评估，但没有发现神经肌肉阻滞的迹象。静脉注射粘菌素似乎是亚胺培南的一种安全有效的替代品，用于治疗由鲍曼不动杆菌碳青霉烯类耐药菌株引起的 VAP。
We prospectively evaluated the efficacy and toxicity of intravenously administered colistin in 35 episodes of ventilator-associated pneumonia (VAP) due to multidrug-resistant Acinetobacter baumannii. Microbiological diagnosis was performed with use of quantitative culture. In 21 patients, the episodes were caused by a strain susceptible exclusively to colistin ( the CO group) and were all treated with this antimicrobial intravenously. In 14 patients, the episodes were caused by strains that remained susceptible to imipenem and were treated with imipenem-cilastatin (the IM group). Acute Physiology and Chronic Health Evaluation II scores at the time of admission and Sequential Organ Failure Assessment scores at time of diagnosis were similar in both groups. VAP was considered clinically cured in 57% of cases in both groups. In-hospital mortality rates were 61.9% in the CO group and 64.2% in the IM group, and the VAP-related mortality rates were 38% and 35.7%, respectively. Four patients in the CO group and 6 in the IM group developed renal failure. Neurophysiological evaluation was performed during 12 episodes in the CO group, but it revealed no signs of neuromuscular blockade. Intravenous colistin appears to be a safe and effective alternative to imipenem for the management of VAP due to carbapenem-resistant strains of A. baumannii.