Betrosian Alex P, Frantzeskaki Frantzeska, Xanthaki Anna, Douzinas Emmanuel E
3rd Department of Critical Care, Athens University, Evgenidion Hospital, Papadiamantopoulou 20, Athens, Greece.
J Infect. 2008 Jun;56(6):432-6. doi: 10.1016/j.jinf.2008.04.002. Epub 2008 May 23.
To compare the safety and efficacy of ampicillin/sulbactam (Amp/Sulb) and colistin (COL) in the treatment of multidrug resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP).
A prospective cohort study in adult critically ill patients with VAP. Patients were randomly assigned to receive Amp/Sulb (9 g every 8h) or COL (3 MIU every 8h) intravenously. Dosage was adjusted according to creatinine clearance.
A total of 28 patients were enrolled (15 COL, 13 Amp/Sulb). Resolution of symptoms and signs occurred in 60% (9/15) of the COL group and 61.5% (9/13) of the Amp/Sulb group, improvement in 13.3% (2/15) vs. 15.3% (1/13) and failure in 26.6% (4/15) vs. 23% (3/13), respectively. The difference was not statistically significant. Bacteriologic success was achieved in 66.6% (10/15) vs. 61.5% (8/13) in the COL and Amp/Sulb groups, respectively (p<0.2). Mortality rates (14 days and 28 days) were 15.3% and 30% for the Amp/Sulb and 20% and 33% for the COL group, respectively. Adverse events were 39.6% (including 33% nephrotoxicity) for the COL group and 30.7% (15.3% nephrotoxicity) for the Amp/Sulb group (p=NS).
Colistin and high-dose ampicillin/sulbactam were comparably safe and effective treatments for critically ill patients with MDR A. baumannii VAP.
比较氨苄西林/舒巴坦（Amp/Sulb）和黏菌素（COL）治疗多重耐药鲍曼不动杆菌呼吸机相关性肺炎（VAP）的安全性和疗效。
对成年重症VAP患者进行前瞻性队列研究。患者被随机分配接受静脉注射Amp/Sulb（每8小时9克）或COL（每8小时300万国际单位）。剂量根据肌酐清除率进行调整。
共纳入28例患者（COL组15例，Amp/Sulb组13例）。COL组60%（9/15）、Amp/Sulb组61.5%（9/13）的患者症状和体征得到缓解，改善率分别为13.3%（2/15）和15.3%（1/13），失败率分别为26.6%（4/15）和23%（3/13）。差异无统计学意义。COL组和Amp/Sulb组的细菌学成功率分别为66.6%（10/15）和61.5%（8/13）（p<0.2）。Amp/Sulb组14天和28天的死亡率分别为15.3%和30%，COL组分别为20%和33%。COL组不良事件发生率为39.6%（包括33%的肾毒性），Amp/Sulb组为30.7%（15.3%的肾毒性）（p=无显著性差异）。
黏菌素和高剂量氨苄西林/舒巴坦对重症多重耐药鲍曼不动杆菌VAP患者的治疗安全性和有效性相当。
