Hsieh Tai-Chin, Chen Fu-Lun, Ou Tsong-Yih, Jean Shio-Shin, Lee Wen-Sen
Division of Infectious Disease, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
J Microbiol Immunol Infect. 2016 Aug;49(4):523-30. doi: 10.1016/j.jmii.2014.08.009. Epub 2014 Oct 31.
Aerosolized colistin methanesulfonate (CMS) has been used for the treatment of extensively drug-resistant Acinetobacter baumannii (XDRAB) pneumonia and eradication of XDRAB colonization in the respiratory tract. The aims of this study were to compare the efficacy, adverse effects, clinical outcomes, and microbiological eradication of the cases of XDRAB pneumonia or colonization.
We retrospectively reviewed the medical records of patients who received aerosolized CMS for the treatment of pneumonia and airway colonization due to XDRAB.
Clinical data from 118 patients were studied. The mean age of 57 patients in the pneumonia group was 79.4 years, and that of 61 patients in the colonization group was 80.0 years. Patients with XDRAB pneumonia were more likely to be ventilator-dependent than colonized patients (46.5% vs. 21.3%; p = 0.005), receive steroid therapy (49.1% vs. 31.1%; p = 0.046), and be admitted to an intensive care unit (ICU) at the time of aerosolized CMS treatment (56.1% vs. 32.8%; p = 0.011). The in-hospital mortality rate was higher in the pneumonia group than the colonization group (50.9% vs. 33.3%; p = 0.05). Microbiological eradication of XDRAB in airway samples was achieved in 75% (89 of 118) patients. In pneumonia patients, XDRAB eradication was associated with resolution or improvement of presenting symptoms and signs of infection by the end of treatment relative to the noneradicated group (57.8% vs. 25%; p = 0.044), but had no influence on 30-day mortality. In colonized patients, no difference in clinical outcomes was noted between the eradicated and noneradicated groups.
Aerosolized CMS therapy has acceptable efficacy for XDRAB pneumonia, but no proven efficacy for XDRAB airway colonization.
雾化吸入多黏菌素甲磺酸盐（CMS）已被用于治疗广泛耐药鲍曼不动杆菌（XDRAB）肺炎及清除呼吸道中的XDRAB定植菌。本研究旨在比较XDRAB肺炎或定植病例的疗效、不良反应、临床结局及微生物清除情况。
我们回顾性分析了接受雾化吸入CMS治疗XDRAB所致肺炎及气道定植的患者的病历。
研究了118例患者的临床资料。肺炎组57例患者的平均年龄为79.4岁，定植组61例患者的平均年龄为80.0岁。XDRAB肺炎患者比定植患者更有可能依赖呼吸机（46.5%对21.3%；p = 0.005），接受类固醇治疗（49.1%对31.1%；p = 0.046），并在雾化吸入CMS治疗时入住重症监护病房（ICU）（56.1%对32.8%；p = 0.011）。肺炎组的院内死亡率高于定植组（50.9%对33.3%；p = 0.05）。118例患者中有75%（89例）的气道样本中XDRAB被微生物清除。在肺炎患者中，与未清除组相比，治疗结束时XDRAB清除与感染的症状和体征缓解或改善相关（57.8%对25%；p = 0.044），但对30天死亡率无影响。在定植患者中，清除组和未清除组的临床结局无差异。
雾化吸入CMS疗法对XDRAB肺炎有可接受的疗效，但对XDRAB气道定植尚无经证实的疗效。
