Liao Chun-Hsing, Sheng Wang-Huei, Chen Yee-Chun, Hung Chien-Ching, Wang Jann-Tay, Chang Shan-Chwen
Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, 7 Chung-Shan South Road, Taipei 100, Taiwan.
J Infect. 2007 Aug;55(2):149-57. doi: 10.1016/j.jinf.2007.01.015. Epub 2007 Mar 21.
Strains of Acinetobacter baumannii resistant to all available antibiotics except polymyxin B have circulated in Taiwan since 1998 and have caused a variety of nosocomial infections. There are no standard tests to measure outcome in patients infected with these strains. Our aim was to determine whether a serum bactericidal test (SBT) could be used for this purpose.
This SBT was performed in 57 infected patients.
Among the 35 patients who survived and 22 patients who died, peak SBT titer negatively correlated with mortality rate (correlation coefficient -0.43). The survival rate in patients with a peak SBT titer > or = 1:16, > or = 1:8, and < or = 1:4 was 100%, 87.5%, and 42.4%, respectively (p=0.001). Mortality was found to be closely related to illness severity and the presence of multiple organ failure. In subgroup analysis, the power of SBT to predict mortality was significant for patients without multiple organ failure (p=0.004), and also patients without disease defined as rapidly fatal by McCabe classification (p=0.044).
In a region with few therapeutic options for multi-drug resistant Acinetobacter baumannii (MDRAB), such as in Taiwan, SBT could be used as a prognosis indicator and indicator of the need to modify treatment in patients infected with MDRAB.
自1998年以来，除多粘菌素B外对所有可用抗生素均耐药的鲍曼不动杆菌菌株在台湾地区传播，并引发了多种医院感染。目前尚无标准检测方法来衡量感染这些菌株的患者的预后。我们的目的是确定血清杀菌试验（SBT）是否可用于此目的。
对57例感染患者进行了该SBT检测。
在35例存活患者和22例死亡患者中，SBT峰值滴度与死亡率呈负相关（相关系数为-0.43）。SBT峰值滴度≥1:16、≥1:8和≤1:4的患者的存活率分别为100%、87.5%和42.4%（p = 0.001）。发现死亡率与疾病严重程度和多器官功能衰竭的存在密切相关。在亚组分析中，SBT预测死亡率的能力对于无多器官功能衰竭的患者（p = 0.004）以及无McCabe分类中定义为快速致命疾病的患者（p = 0.044）具有显著意义。
在台湾这样对多重耐药鲍曼不动杆菌（MDRAB）治疗选择有限的地区，SBT可作为感染MDRAB患者的预后指标以及调整治疗必要性的指标。
