Department of Pharmacy, Harborview Medical Center, Seattle, WA 98104, USA.
J Intensive Care Med. 2010 Nov-Dec;25(6):343-8. doi: 10.1177/0885066610377975.
Carbapenem-resistant (CR) Acinetobacter baumannii is an important pathogen in ventilator-associated pneumonia (VAP), but therapeutic options are limited. We describe the clinical outcomes of the largest case series of CR-Acinetobacter VAP reported to date.
A retrospective analysis of 55 participants with CR-Acinetobacter VAP from July 2004 to December 2007 was undertaken. The primary endpoint was clinical response or microbiological eradication. Secondary endpoint was treatment-associated nephrotoxicity defined as ≥ 50% increase in serum creatinine or an increase of ≥ 0.5 mg/dL during therapy.
Forty-two (76.4%) participants achieved clinical response at the completion of therapy. Clinical responses were achieved in 60.0% of sulbactam-based, 66.7% of polymyxin-based, 77.8% of aminoglycoside-based, 80.6% of minocycline-based, and 90.0% of tigecycline-based regimens. Follow-up sputum cultures were available in 6 of 10 tigecycline-treated participants with 4 of 6 isolates developing intermediate resistance to tigecycline while on therapy. Ten (18.2%) participants without preexisting renal disease developed treatment-associated nephrotoxicity. Baseline serum creatinine was 0.9 ± 0.1 mg/dL (range: 0.6-1.0 mg/dL) at the start of therapy and peaked at 1.9 ± 0.5 mg/dL (range: 1.6-3.0 mg/dL) during therapy. After excluding other potential concomitant renal toxic agents, nephrotoxicity developed in 6 of 30 (20.0%) and 4 of 7 (57.1%) participants treated with an aminoglycoside-or polymyxin-based regimen, respectively.
Our results demonstrated that CR-Acinetobacter VAP can be effectively treated with second-line agents. However, colistin-related nephrotoxicity was much higher than recently reported and decreased susceptibility to tigecycline emerged on therapy demonstrating the limitations of alternative regimens.
耐碳青霉烯类（CR）鲍曼不动杆菌是呼吸机相关性肺炎（VAP）的重要病原体，但治疗选择有限。我们描述了迄今为止报道的最大的耐碳青霉烯类鲍曼不动杆菌 VAP 病例系列的临床结果。
对 2004 年 7 月至 2007 年 12 月期间 55 例耐碳青霉烯类鲍曼不动杆菌 VAP 患者进行回顾性分析。主要终点是临床反应或微生物学清除。次要终点是治疗相关的肾毒性，定义为治疗期间血清肌酐增加≥50%或增加≥0.5mg/dL。
42 例（76.4%）患者在治疗结束时达到临床反应。基于舒巴坦、多粘菌素、氨基糖苷类、米诺环素和替加环素的方案的临床反应率分别为 60.0%、66.7%、77.8%、80.6%和 90.0%。10 例接受替加环素治疗的患者中有 6 例可获得随访痰液培养，其中 4 例在治疗期间对替加环素的中介耐药性增加。10 例（18.2%）无原有肾脏疾病的患者发生治疗相关的肾毒性。治疗开始时的血清肌酐为 0.9±0.1mg/dL（范围：0.6-1.0mg/dL），治疗期间峰值为 1.9±0.5mg/dL（范围：1.6-3.0mg/dL）。在排除其他潜在的肾毒性药物后，分别有 6 例（20.0%）和 4 例（57.1%）接受氨基糖苷类或多粘菌素类方案治疗的患者出现肾毒性。
我们的结果表明，耐碳青霉烯类鲍曼不动杆菌 VAP 可以用二线药物有效治疗。然而，多粘菌素相关的肾毒性比最近报道的要高得多，并且在治疗过程中出现了对替加环素的敏感性降低，这表明替代方案存在局限性。
