复方磺胺甲噁唑与多黏菌素或氨苄西林/舒巴坦治疗碳青霉烯类耐药鲍曼不动杆菌：一项回顾性匹配队列研究。
Trimethoprim-sulfamethoxazole vs. colistin or ampicillin-sulbactam for the treatment of carbapenem-resistant Acinetobacter baumannii: A retrospective matched cohort study.
机构信息
Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel; Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; The Bruce Rappaport Faculty of Medicine - Technion Israel Institute of Technology, Haifa, Israel.
Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel.
出版信息
J Glob Antimicrob Resist. 2019 Jun;17:168-172. doi: 10.1016/j.jgar.2018.12.001. Epub 2018 Dec 14.
OBJECTIVES
This study aimed to assess the effectiveness of trimethoprim-sulfamethoxazole (TMP/SMX) as monotherapy for the treatment of carbapenem-resistant Acinobacter baumannii (A. baumannii) (CRAB) infections.
METHODS
This retrospective cohort study included patients receiving TMP/SMX as the main treatment for severe infections caused by CRAB, who were matched with patients treated with colistin or ampicillin-sulbactam (AMP/SUL) by age, Charlson score, department, and source of infection. Outcomes were compared among all patients and in a subgroup of propensity-score (PS) matched patients. The PS matching was performed using a match tolerance of 0.15 with replacement.
RESULTS
Fifty-three patients treated with TMP/SMX and 83 matched patients treated with colistin or AMP/SUL were included. Variables that were independently significantly associated with TMP/SMX treatment included admission for infection and septic shock, while abnormal cognition on admission and intensive care unit admission were associated with colistin or AMP/SUL treatment. All-cause 30-day mortality was lower with TMP/SMX compared with the comparator antibiotics among all patients (24.5%, 13 of 53 vs. 38.6%, 32 of 83, P=0.09) and in the PS-matched subgroup (29%, 9 of 31 vs. 55.2% 16 of 29, P=0.04). Treatment failure rates were not significantly different overall (34%, 18 of 53 vs. 42.4%, 35 of 83, P=0.339) and in the PS-matched subgroup (35.5%, 11 of 31 vs. 44.8%, 13 of 29, P=0.46). Time to clinical stability and hospitalization duration were significantly shorter with TMP/SMX. Patients treated with TMP/SMX probably had less severe infections than those treated with other antibiotics, even after matching.
CONCLUSIONS
TMP/SMX might be a valuable treatment option for TMP/SMX-susceptible CRAB infections. Given the very limited available treatment options, further studies assessing its effectiveness and safety are necessary.
目的
本研究旨在评估复方磺胺甲噁唑（TMP/SMX）单药治疗耐碳青霉烯鲍曼不动杆菌（CRAB）感染的疗效。
方法
本回顾性队列研究纳入了接受 TMP/SMX 作为主要治疗方案治疗由 CRAB 引起的严重感染的患者，并按年龄、Charlson 评分、科室和感染源与接受多粘菌素或氨苄西林-舒巴坦（AMP/SUL）治疗的患者进行匹配。比较了所有患者和倾向评分（PS）匹配患者亚组的结果。PS 匹配采用替换的容差为 0.15 的匹配方法。
结果
共纳入 53 例接受 TMP/SMX 治疗和 83 例匹配接受多粘菌素或 AMP/SUL 治疗的患者。与 TMP/SMX 治疗相关的独立显著变量包括因感染和感染性休克入院，而入院时认知功能异常和入住重症监护病房与多粘菌素或 AMP/SUL 治疗相关。与比较抗生素相比，所有患者（24.5%，53 例中的 13 例 vs. 38.6%，83 例中的 32 例，P=0.09）和 PS 匹配亚组（29%，31 例中的 9 例 vs. 55.2%，29 例中的 16 例，P=0.04）中，TMP/SMX 治疗的 30 天全因死亡率较低。总体上（34%，53 例中的 18 例 vs. 42.4%，83 例中的 35 例，P=0.339）和 PS 匹配亚组（35.5%，31 例中的 11 例 vs. 44.8%，29 例中的 13 例，P=0.46）中，治疗失败率无显著差异。TMP/SMX 治疗的临床稳定时间和住院时间明显缩短。即使在匹配后，接受 TMP/SMX 治疗的患者的感染可能比接受其他抗生素治疗的患者的感染更轻。
结论
TMP/SMX 可能是治疗 TMP/SMX 敏感 CRAB 感染的有价值的治疗选择。鉴于可用的治疗选择非常有限，有必要进一步评估其有效性和安全性。
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