Shojaei Lida, Mohammadi Mostafa, Beigmohammadi Mohammad-Taghi, Doomanlou Mahsa, Abdollahi Alireza, Feizabadi Mohammad Mehdi, Khalili Hossein
Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Department of Intensive Care Unit, Imam Khomeini Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Microbiol. 2016 Oct;8(5):288-297.
The frequency of multi-drug resistant . infections is increasing in Iran. Considering availability of limited therapeutic options, clinical response and outcome of ventilator-associated pneumonia due to multi-drug resistant were evaluated in critically ill patients.
In this prospective study, 29 patients with carbapenem resistance ventilator-associated pneumonia were enrolled. Endotracheal aspirate specimens were analyzed according to the clinical and laboratory standard institute instructions in the hospital's microbiology laboratory. Demographics, clinical, microbiological and laboratory findings were collected for each patient during the treatment course. Therapeutic empirical regimen, change in antibiotic regimen following receiving antibiogram results, clinical and microbiological responses, duration of ICU stay and outcome were collected for each recruited individual.
All of isolates were resistant to pipracillin-tazobactam, ceftriaxon, amikacin and ciprofloxacin. The resistance rate of species was 41.4% for ampicillin/sulbactabm and 93.1% for meropenem. Patients received either meropenem/colistin (51.7%) or meropenem/ampicillin-sulbactam (48.3%) as the treatment regimens based on the antimicrobial susceptibility patterns of isolates. Ventilator-associated pneumonia clinical response, improvement and failure achieved in 15 (51.7%), 8 (27.6%) and 6 (20.7%) of the patients respectively. Microbiological eradication and intermediate status were observed in 9/29 (31%) and 11/29 (37.9%) of patients, respectively.
The antibiotic regimens showed comparable efficacy in treatment of VAP due to MDR but mortality rate was high. Considering widespread and high mortality rates associated with MDR infections, applying infection control and antibiotic stewardship programs in hospitals are essential.
伊朗耐多药感染的发生率正在上升。鉴于治疗选择有限，对重症患者中耐多药所致呼吸机相关性肺炎的临床反应及结局进行了评估。
在这项前瞻性研究中，纳入了29例患有碳青霉烯耐药呼吸机相关性肺炎的患者。按照临床和实验室标准协会的说明，在医院微生物实验室对气管内吸出物标本进行分析。在治疗过程中收集每位患者的人口统计学、临床、微生物学和实验室检查结果。收集每位入选个体的治疗经验性方案、收到药敏结果后抗生素方案的变化、临床和微生物学反应、重症监护病房住院时间及结局。
所有分离株均对哌拉西林 - 他唑巴坦、头孢曲松、阿米卡星和环丙沙星耐药。分离菌株对氨苄西林/舒巴坦的耐药率为41.4%，对美罗培南的耐药率为93.1%。根据分离株的抗菌药敏模式，患者接受美罗培南/黏菌素（51.7%）或美罗培南/氨苄西林 - 舒巴坦（48.3%）作为治疗方案。分别有15例（51.7%）、8例（27.6%）和6例（20.7%）患者的呼吸机相关性肺炎临床反应为改善、好转和失败。分别有9/29（31%）和11/29（37.9%）的患者观察到微生物清除和中间状态。
抗生素方案在治疗耐多药所致呼吸机相关性肺炎方面显示出相当的疗效，但死亡率较高。鉴于耐多药感染的广泛存在和高死亡率，在医院实施感染控制和抗生素管理计划至关重要。
