Ceccarelli Giancarlo, Oliva Alessandra, d'Ettorre Gabriella, D'Abramo Alessandra, Caresta Elena, Barbara Caterina Silvia, Mascellino Maria Teresa, Papoff Paola, Moretti Corrado, Vullo Vincenzo, Visca Paolo, Venditti Mario
Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Viale del Policlinico 155, Rome, Italy.
Azienda Policlinico Umberto I, Viale del Policlinico 155, Rome, Italy.
BMC Infect Dis. 2015 Sep 30;15:393. doi: 10.1186/s12879-015-1133-3.
Acinetobacter baumannii has been associated with high morbidity and mortality rates, even in pediatric patients. Therapeutic options are limited, especially when the strain is multidrug resistant.
Clinical and microbiological analyses of 4 cases of systemic infections caused by multi drug resistant A. baumannii treated with colistin/vancomycin combination at a Pediatric Intensive Care Unit were performed in order to explore the potential synergistic activity of colistin plus vancomycin. All the patients were treated with colistin, meropenem and vancomycin.
Four severe infections due to MDR A. baumannii were observed. All patients treated with colistin/vancomycin combination had a positive outcome with no infection relapses. Most importantly, no significant adverse events related to the simultaneous administration of COL plus VAN were observed. In our in-vitro experiments, the synergistic effect of the combination COL plus VAN showed an early bactericidal activity even at VAN concentration of 16 mg/L, which reflects the serum trough concentrations obtained in patients.
An antimicrobial strategy based on the activity of colistin plus vancomycin was in-vitro and in-vivo effective in life-threatening infections caused by multidrug-resistant A. baumannii in a Pediatric Intensive Care Unit, in the absence of adverse effects. Colistin plus vancomycin were highly synergic and bactericidal against carbapenem-resistant, colistin sensitive A. baumannii whereas the addition of meropenem did not enhance the in-vitro activity of colistin plus vancomycin.
Our results confirm existing data on the potential synergistic activity of a therapeutic strategy including colistin plus vancomycin and provide important new clinical information for its potential use as a therapeutic option against MDR A. baumannii infections, especially in the pediatric population.
鲍曼不动杆菌即便在儿科患者中也与高发病率和死亡率相关。治疗选择有限，尤其是当菌株具有多重耐药性时。
对在儿科重症监护病房接受黏菌素/万古霉素联合治疗的4例由多重耐药鲍曼不动杆菌引起的全身感染病例进行临床和微生物学分析，以探究黏菌素加万古霉素的潜在协同活性。所有患者均接受了黏菌素、美罗培南和万古霉素治疗。
观察到4例由多重耐药鲍曼不动杆菌引起的严重感染。所有接受黏菌素/万古霉素联合治疗的患者均取得了良好疗效，且无感染复发。最重要的是，未观察到与同时使用黏菌素和万古霉素相关的显著不良事件。在我们的体外实验中，即便万古霉素浓度为16mg/L时，黏菌素加万古霉素的联合用药也显示出早期杀菌活性，这反映了患者体内的血清谷浓度。
基于黏菌素加万古霉素活性的抗菌策略在儿科重症监护病房对由多重耐药鲍曼不动杆菌引起的危及生命的感染在体外和体内均有效，且无不良反应。黏菌素加万古霉素对碳青霉烯耐药、对黏菌素敏感的鲍曼不动杆菌具有高度协同和杀菌作用，而添加美罗培南并未增强黏菌素加万古霉素的体外活性。
我们的结果证实了关于包括黏菌素加万古霉素在内的治疗策略的潜在协同活性的现有数据，并为其作为治疗多重耐药鲍曼不动杆菌感染的治疗选择的潜在用途提供了重要的新临床信息，尤其是在儿科人群中。
