Division of Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW 2308, Australia.
Division of Medicine, John Hunter Hospital, Newcastle, NSW 2305, Australia.
Int J Antimicrob Agents. 2018 Jun;51(6):862-866. doi: 10.1016/j.ijantimicag.2018.01.018. Epub 2018 May 18.
Gram-negative bacilli are the causative organisms in a significant proportion of patients with severe community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU). Clinical guidelines recommend broad-spectrum antimicrobials for empirical treatment despite alarming global trends in antimicrobial resistance. In this study, we aimed to assess the safety and efficacy of gentamicin, an aminoglycoside with potent bactericidal activity, for empirical Gram-negative coverage of severe CAP in patients admitted to the ICU. A retrospective cohort study was performed at a university teaching hospital where the severe CAP guideline recommends penicillin, azithromycin and gentamicin as empirical cover. Ceftriaxone plus azithromycin is used as an alternative. Adults with radiologically-confirmed severe CAP were included, comparing those who received gentamicin in the first 72 h of admission with those who did not. Participants were identified using ICD-10 codes for bacterial pneumonia and data manually extracted from electronic medical records. Of 148 patients admitted with severe pneumonia, 117 were given at least one dose of gentamicin whereas the remaining 31 were not. The two groups were well matched in terms of demographics, co-morbidities and disease severity. There were no significant differences between the gentamicin and no-gentamicin groups in the incidence of acute kidney injury [60/117 (51%) vs. 16/31 (52%), respectively], hospital mortality [20/117 (17%) vs. 7/31 (23%)] and secondary outcomes including relapse and length of hospital stay. In conclusion, gentamicin is safe and has similar outcomes to alternative Gram-negative antimicrobial regimens for empirical coverage in severe CAP patients admitted to the ICU.
革兰氏阴性杆菌是重症社区获得性肺炎（CAP）患者中相当一部分患者的致病微生物，这些患者被收入重症监护病房（ICU）。尽管全球范围内出现了令人震惊的抗生素耐药趋势，但临床指南仍建议使用广谱抗生素进行经验性治疗。在这项研究中，我们旨在评估氨基糖苷类药物庆大霉素对重症 CAP 患者 ICU 经验性革兰氏阴性覆盖的安全性和疗效。这是一项在一所大学教学医院进行的回顾性队列研究，该医院的重症 CAP 指南建议使用青霉素、阿奇霉素和庆大霉素作为经验性覆盖，头孢曲松加阿奇霉素则作为替代方案。研究纳入了经影像学证实患有重症 CAP 的成年人，比较了在入院的前 72 小时内接受庆大霉素治疗的患者和未接受庆大霉素治疗的患者。使用 ICD-10 编码对细菌性肺炎的患者进行识别，并从电子病历中手动提取数据。在 148 名因重症肺炎入院的患者中，117 名患者至少接受了一剂庆大霉素，而其余 31 名患者未接受。在人口统计学特征、合并症和疾病严重程度方面，两组患者具有可比性。庆大霉素组和未用庆大霉素组在急性肾损伤的发生率[60/117（51%）与 16/31（52%）]、住院死亡率[20/117（17%）与 7/31（23%）]以及包括复发和住院时间在内的次要结局方面均无显著差异。总之，对于 ICU 收治的重症 CAP 患者，庆大霉素是一种安全且有效的经验性革兰氏阴性覆盖的替代抗生素方案。
