Master Program of Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; Ph.D. Program in Toxicology, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Clin Microbiol Infect. 2018 Aug;24(8):908.e1-908.e7. doi: 10.1016/j.cmi.2017.10.033. Epub 2017 Nov 3.
This study aimed to investigate antibiotic prescribing patterns and effectiveness of different anti-carbapenem-resistant Acinetobacter baumannii (CRAB) strategies for CRAB pneumonia.
We conducted a multicentre, retrospective study in three hospitals. During 2010-2015, adult ICU patients with CRAB pneumonia treated with at least one antimicrobial agent covering the CRAB isolate in vitro for more than 2 days were included. We used multivariate logistic regression to analyse the associations of anti-CRAB strategies with ICU mortality and other clinical outcomes.
Among 238 patients with CRAB pneumonia, tigecycline monotherapy (84, 35.3%) was the most common antibiotic strategy, followed by tigecycline with colistin (43, 18.1%), colistin monotherapy (34, 14.3%), colistin combination without tigecycline (33, 13.9%), tigecycline combination without colistin (32, 13.4%), and sulbactam-based therapy without tigecycline and colistin (12, 5.0%). In multivariate analysis, tigecycline-based therapy was associated with higher ICU mortality than non-tigecycline therapy (adjusted OR 2.30, 95% CI 1.19-4.46). There was no difference between colistin-based therapy and non-colistin therapy. Compared with tigecycline monotherapy, colistin monotherapy was associated with lower ICU mortality (aOR 0.30, 95% CI 0.10-0.88). Treatment failure analyses showed similar trends. Tigecycline-based therapy was associated with higher treatment failure rate than non-tigecycline therapy (aOR 2.51, 95% CI 1.39-4.54), whereas colistin-based therapy was associated with lower treatment failure rate than non-colistin-based therapy (aOR 0.48, 95% CI 0.27-0.86).
Tigecycline was commonly prescribed for CRAB pneumonia. However, tigecycline-based therapy was associated with higher ICU mortality and treatment failure. Our study suggests that colistin monotherapy may be a better antibiotic strategy for CRAB pneumonia.
本研究旨在调查不同抗耐碳青霉烯鲍曼不动杆菌（CRAB）策略在治疗 CRAB 肺炎中的抗生素应用模式和效果。
我们进行了一项多中心、回顾性研究，纳入了 2010 年至 2015 年期间在三家医院接受至少一种覆盖 CRAB 分离株的抗生素治疗超过 2 天的成人 ICU 患者。我们使用多变量逻辑回归分析抗 CRAB 策略与 ICU 死亡率和其他临床结局的关系。
在 238 例 CRAB 肺炎患者中，替加环素单药治疗（84 例，35.3%）是最常见的抗生素策略，其次是替加环素联合黏菌素（43 例，18.1%）、黏菌素单药治疗（34 例，14.3%）、不联合替加环素的黏菌素联合治疗（33 例，13.9%）、不联合黏菌素的替加环素联合治疗（32 例，13.4%）和不联合替加环素和黏菌素的舒巴坦治疗（12 例，5.0%）。多变量分析显示，替加环素治疗与 ICU 死亡率较高相关（调整后的 OR 2.30，95%CI 1.19-4.46）。黏菌素治疗与非黏菌素治疗之间无差异。与替加环素单药治疗相比，黏菌素单药治疗与 ICU 死亡率较低相关（aOR 0.30，95%CI 0.10-0.88）。治疗失败分析显示出类似的趋势。替加环素治疗与治疗失败率较高相关（aOR 2.51，95%CI 1.39-4.54），而黏菌素治疗与治疗失败率较低相关（aOR 0.48，95%CI 0.27-0.86）。
替加环素常用于治疗 CRAB 肺炎。然而，替加环素治疗与 ICU 死亡率和治疗失败率较高相关。我们的研究表明，黏菌素单药治疗可能是治疗 CRAB 肺炎的更好抗生素策略。
