Kim Won-Young, Moon Jae-Young, Huh Jin Won, Choi Sang-Ho, Lim Chae-Man, Koh Younsuck, Chong Yong Pil, Hong Sang-Bum
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
PLoS One. 2016 Mar 2;11(3):e0150642. doi: 10.1371/journal.pone.0150642. eCollection 2016.
Tigecycline has in vitro activity against multidrug-resistant and extensively drug-resistant Acinetobacter baumannii (MDR/XDRAB), and may constitute an alternative therapy for treating pneumonia caused by MDR/XDRAB. The aim of this study was to compare the efficacy of tigecycline-based therapy with colistin-based therapy in patients with MDR/XDRAB pneumonia. Between January 2009 and December 2010, patients in the intensive care unit who were diagnosed with MDR/XDRAB pneumonia and treated with either tigecycline or colistin mono-/combination therapy were reviewed. A total of 70 patients were included in our analysis. Among them, 30 patients received tigecycline-based therapy, and 40 patients received colistin-based therapy. Baseline characteristics were similar in the two groups. Clinical success rate was 47% in the tigecycline group and 48% in the colistin group (P = 0.95). There were no differences between the groups with regard to other clinical outcomes, with the exception that nephrotoxicity was observed only in the colistin group (0% vs. 20%; P = 0.009). Clinical and microbiological success rates were numerically higher, and mortality rates were numerically lower in combination therapy group than in the monotherapy group. Multivariate analysis indicated that monotherapy was independently associated with increased clinical failure (aOR, 3.96; 95% CI, 1.03-15.26; P = 0.046). Our results suggest that tigecycline-based therapy was tolerable and the clinical outcome was comparable to that of colistin-based therapy for patients with MDR/XDRAB pneumonia. In addition, combination therapy may be more useful than monotherapy in treatment of MDR/XDRAB pneumonia.
替加环素对多重耐药和广泛耐药鲍曼不动杆菌（MDR/XDRAB）具有体外活性，可能构成治疗由MDR/XDRAB引起的肺炎的替代疗法。本研究的目的是比较以替加环素为基础的治疗与以多黏菌素为基础的治疗对MDR/XDRAB肺炎患者的疗效。回顾了2009年1月至2010年12月在重症监护病房被诊断为MDR/XDRAB肺炎并接受替加环素或多黏菌素单药/联合治疗的患者。共有70例患者纳入我们的分析。其中，30例患者接受以替加环素为基础的治疗，40例患者接受以多黏菌素为基础的治疗。两组的基线特征相似。替加环素组的临床成功率为47%，多黏菌素组为48%（P = 0.95）。两组在其他临床结局方面无差异，唯一例外的是仅在多黏菌素组观察到肾毒性（0%对20%；P = 0.009）。联合治疗组的临床和微生物学成功率在数值上更高，死亡率在数值上更低。多变量分析表明，单药治疗与临床失败增加独立相关（校正比值比，3.96；95%置信区间，1.03 - 15.26；P = 0.046）。我们的结果表明，对于MDR/XDRAB肺炎患者，以替加环素为基础的治疗是可耐受的，临床结局与以多黏菌素为基础的治疗相当。此外，联合治疗在治疗MDR/XDRAB肺炎方面可能比单药治疗更有用。
