Wood G Christopher, Jonap Brittany L, Maish George O, Magnotti Louis J, Swanson Joseph M, Boucher Bradley A, Croce Martin A, Fabian Timothy C
1 University of Tennessee Health Science Center, Memphis, TN, USA.
Ann Pharmacother. 2018 Feb;52(2):120-125. doi: 10.1177/1060028017730838. Epub 2017 Sep 14.
Achromobacter sp are nonfermenting Gram-negative bacilli (NFGNB) that rarely cause severe infections, including ventilator-associated pneumonia (VAP). Data on the treatment of Achromobacter pneumonia are very limited, and the organism has been associated with a high mortality rate. Thus, more data are needed on treating this organism.
To evaluate the treatment of Achromobacter VAP in critically ill trauma patients.
This retrospective, observational study evaluated critically ill trauma patients who developed Achromobacter VAP. A previously published pathway for the diagnosis and management of VAP was used according to routine patient care. This included the use of quantitative bronchoscopic bronchoalveolar lavage cultures to definitively diagnose VAP.
A total of 37 episodes of Achromobacter VAP occurred in 34 trauma intensive care unit patients over a 15-year period. The most commonly used definitive antibiotics were imipenem/cilastatin, cefepime, or trimethoprim/sulfamethoxazole. The primary outcome of clinical success was achieved in 32 of 37 episodes (87%). This is similar to previous studies of other NFGNB VAP (eg, Pseudomonas, Acinetobacter) from the study center. Microbiological success was seen in 21 of 28 episodes (75%), and VAP-related mortality was 9% (3 of 34 patients).
Achromobacter is a rare but potentially serious cause of VAP in critically ill patients. In this study, there was an acceptable success rate compared with other causes of NFGNB VAP in this patient population.
无色杆菌属是非发酵革兰氏阴性杆菌（NFGNB），很少引起严重感染，包括呼吸机相关性肺炎（VAP）。关于无色杆菌肺炎治疗的数据非常有限，且该病原体与高死亡率相关。因此，需要更多关于治疗这种病原体的数据。
评估危重症创伤患者中无色杆菌VAP的治疗情况。
这项回顾性观察研究评估了发生无色杆菌VAP的危重症创伤患者。根据常规患者护理，采用先前发表的VAP诊断和管理路径。这包括使用定量支气管镜支气管肺泡灌洗培养来明确诊断VAP。
在15年期间，34名创伤重症监护病房患者共发生37例无色杆菌VAP。最常用的确定性抗生素是亚胺培南/西司他丁、头孢吡肟或甲氧苄啶/磺胺甲恶唑。37例中有32例（87%）取得了临床成功的主要结局。这与该研究中心之前对其他NFGNB VAP（如假单胞菌、不动杆菌）的研究结果相似。28例中有21例（75%）取得了微生物学成功，VAP相关死亡率为9%（34例患者中有3例）。
无色杆菌是危重症患者VAP的一种罕见但潜在严重的病因。在本研究中，与该患者群体中其他NFGNB VAP病因相比，成功率是可接受的。
