Oliveira M S, Prado G V B, Costa S F, Grinbaum R S, Levin A S
Department of Infection Control of Hospital das Clínicas, Rua Dr Ovídio Pires de Campos, 225, Sala 629, São Paulo-SP 05403-010, Brazil.
J Antimicrob Chemother. 2008 Jun;61(6):1369-75. doi: 10.1093/jac/dkn128. Epub 2008 Mar 25.
There has been an increase in worldwide infections caused by carbapenem-resistant Acinetobacter. This poses a therapeutic challenge as few treatment options are available.
The aim of this study was to evaluate the efficacy and safety of polymyxins and ampicillin/sulbactam for treating infections caused by carbapenem-resistant Acinetobacter spp. and to evaluate prognostic factors.
This was a retrospective review of patients from two teaching hospitals who had nosocomial infections caused by carbapenem-resistant Acinetobacter spp. from 1996 to 2004. Diagnosis of infection was based on CDC criteria plus the isolation of Acinetobacter from a usually sterile site or from bronchoalveolar lavage. Urinary tract infections were not included. Data on demographic and clinical features and treatment were collected from medical records. Prognostic factors associated with two outcomes (mortality during treatment and in-hospital mortality) were evaluated.
Eighty-two patients received polymyxins and 85 were treated with ampicillin/sulbactam. Multiple logistic regression analysis revealed that independent predictors of mortality during treatment were treatment with polymyxins, higher Acute Physiological and Chronic Health Evaluation II (APACHE II) score, septic shock, delay in starting treatment and renal failure. On multivariate analysis, prognostic factors for in-hospital mortality were older age, septic shock and higher APACHE II score.
This is the first study comparing current therapeutic options for infections due to carbapenem-resistant Acinetobacter. The most important finding of the present study is that ampicillin/sulbactam appears to be more efficacious than polymyxins, which was an independent factor associated with mortality during treatment.
耐碳青霉烯类不动杆菌引起的全球感染有所增加。由于可用的治疗选择很少，这带来了治疗挑战。
本研究的目的是评估多粘菌素和氨苄西林/舒巴坦治疗耐碳青霉烯类不动杆菌属感染的疗效和安全性，并评估预后因素。
这是一项对1996年至2004年在两家教学医院发生耐碳青霉烯类不动杆菌属医院感染患者的回顾性研究。感染的诊断基于美国疾病控制与预防中心（CDC）标准以及从通常无菌部位或支气管肺泡灌洗中分离出不动杆菌。不包括尿路感染。从病历中收集人口统计学、临床特征和治疗数据。评估与两个结局（治疗期间死亡率和院内死亡率）相关的预后因素。
82例患者接受了多粘菌素治疗，85例接受了氨苄西林/舒巴坦治疗。多因素logistic回归分析显示，治疗期间死亡的独立预测因素是使用多粘菌素治疗、较高的急性生理与慢性健康状况评分系统II（APACHE II）评分、感染性休克、开始治疗延迟和肾衰竭。多变量分析显示，院内死亡的预后因素是年龄较大、感染性休克和较高的APACHE II评分。
这是第一项比较当前治疗耐碳青霉烯类不动杆菌感染的治疗选择的研究。本研究最重要的发现是，氨苄西林/舒巴坦似乎比多粘菌素更有效，多粘菌素是与治疗期间死亡率相关的独立因素。
