Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
Int J Antimicrob Agents. 2014 Apr;43(4):378-82. doi: 10.1016/j.ijantimicag.2014.01.016. Epub 2014 Feb 14.
Data for treatment and outcomes of extensively drug-resistant Acinetobacter baumannii (XDR-AB) pneumonia are limited. A retrospective cohort study of 236 adult patients with XDR-AB pneumonia was conducted between January 2009 and December 2012. The median age of subjects was 70 years (range 17-95 years), 53% were male, 55% had ventilator-associated pneumonia and 42% had been admitted to the intensive care unit. All XDR-AB isolates were susceptible only to tigecycline and colistin; 52 (22%) of the 236 subjects did not receive an agent active against XDR-AB, with an associated 28-day survival of 0%. Colistin-based two-drug combination treatment was prescribed to 166 subjects (70%); regimens included (i) colistin and high-dose sulbactam (n=93); (ii) colistin and tigecycline (n=43); and (iii) colistin and high-dose prolonged infusion of a carbapenem (n=30). The 28-day survival rate and mean length of hospital stay were not statistically different between these three regimens (65%, 53% and 60% and 39, 39 and 38 days, respectively). Predictors of mortality included Acute Physiology and Chronic Health Evaluation (APACHE) II score [adjusted odds ratio (aOR)=1.11; P<0.001 for each point increase], duration from infection onset to receipt of active regimen (aOR=1.01; P=0.002 for each hour delay), underlying malignancy (aOR=3.46; P=0.01) and chronic kidney disease (aOR=2.85; P=0.03). These findings suggest that the three colistin-based two-drug combination regimens may be treatment options for XDR-AB pneumonia.
广泛耐药鲍曼不动杆菌（XDR-AB）肺炎的治疗和结局数据有限。2009 年 1 月至 2012 年 12 月期间进行了一项对 236 例 XDR-AB 肺炎成年患者的回顾性队列研究。研究对象的中位年龄为 70 岁（范围 17-95 岁），53%为男性，55%患有呼吸机相关性肺炎，42%曾入住重症监护病房。所有 XDR-AB 分离株仅对替加环素和黏菌素敏感；236 例患者中有 52 例（22%）未接受针对 XDR-AB 的有效药物治疗，其 28 天生存率为 0%。166 例（70%）患者接受了基于黏菌素的两药联合治疗；方案包括（i）黏菌素和高剂量舒巴坦（n=93）；（ii）黏菌素和替加环素（n=43）；和（iii）黏菌素和高剂量延长输注碳青霉烯（n=30）。这三种方案的 28 天生存率和平均住院时间无统计学差异（分别为 65%、53%和 60%，39、39 和 38 天）。死亡率的预测因素包括急性生理学和慢性健康评估（APACHE）Ⅱ评分[校正优势比（aOR）=1.11；每增加 1 分，P<0.001]、从感染发病到接受有效方案的时间（aOR=1.01；每延迟 1 小时，P=0.002）、基础恶性肿瘤（aOR=3.46；P=0.01）和慢性肾脏病（aOR=2.85；P=0.03）。这些发现表明，三种基于黏菌素的两药联合方案可能是 XDR-AB 肺炎的治疗选择。
