Huang Yuqin, Zhou Quan, Wang Wenguo, Huang Qiang, Liao Juan, Li Junyi, Long Lei, Ju Tao, Zhang Quan, Wang Hanqin, Xu Huaqiang, Tu Mingli
Intensive Care Unit, Suizhou Central Hospital, Hubei University of Medicine, Suizhou, China.
Suixian People's Hospital, Suizhou, China.
Front Pharmacol. 2019 Feb 13;10:92. doi: 10.3389/fphar.2019.00092. eCollection 2019.
To evaluate therapeutic efficacy of different combined antimicrobial treatments against ventilator-associated pneumonia (VAP). Clinical outcomes were retrospectively analyzed to elucidate the efficacy of four combined antimicrobial regimens. The chessboard and micro broth dilution methods determined the minimum inhibitory concentrations (MICs) of four antiseptic drugs singly used and combined two drugs against 36 isolates of multidrug-resistant (MDR) . The incidence of VAP was approximately 6.9% (237/3424) between January 1, 2015 and December 31, and 35.9% (85/237) of the cases were caused by . Among these cases, 60 belonged to AB-VAP, for whom antimicrobial treatment plan was centralized and clinical data was complete. Moreover, all 60 strains of were MDR bacteria from reports microbiological laboratory. Resistance rate was lowest for amikacin (68.3%) and ampicillin sulbactam (71.7%). Resistance rate for imipenem increased from 63.2 to 90.9% during the 3 years. However, in these 60 cases of AB-VAP, the combination between 4 antibiotics was effective in most cases: the effective rate was 75% (18/24) for sulbactam combined with etilmicin, 71.4% (10/14) for sulbactam combined with levofloxacin, 72.7% (8/11) for meropenem combined with etilmicin, and 63.6% (7/11) for meropenem combined with levofloxacin. There was no statistical difference between four regimens ( > 0.05). Sulbactam combined with etilmicin decreased 1/2 of MIC and MIC of sulbactam while the decreases in etilmicin were more obviously than single drug. When adopting meropenem combined with levofloxacin or etilmicin, the MIC of meropenem reduced to 1/2 of that in applying single drug. As for sulbactam or meropenem combined with levofloxacin, it also lessened the MIC of levofloxacin to 1/2 of that for single drug. FIC results suggested that the effects of four combined antimicrobial regimens were additive or unrelated. When sulbactam was combined with etimicin, the additive effect was 63.89%. Drug combination sensitivity test may be helpful for choosing antimicrobial treatment plans. Sulbactam or meropenem as the basis of treatment regimens can function as the alternatives against AB-VAP. Sulbactam combined with etimicin has been regarded as a recommended regimen in Suizhou, Hubei, China.
评估不同联合抗菌治疗方案对呼吸机相关性肺炎（VAP）的治疗效果。回顾性分析临床结果以阐明四种联合抗菌方案的疗效。采用棋盘法和微量肉汤稀释法测定了四种抗菌药物单独使用及两两联合对36株多重耐药（MDR）菌的最低抑菌浓度（MIC）。2015年1月1日至12月31日期间VAP的发生率约为6.9%（237/3424），其中35.9%（85/237）的病例由……引起。在这些病例中，60例属于鲍曼不动杆菌所致VAP（AB-VAP），其抗菌治疗方案集中制定且临床资料完整。此外，所有60株鲍曼不动杆菌均为微生物实验室报告的MDR菌。阿米卡星的耐药率最低（68.3%），氨苄西林舒巴坦的耐药率为71.7%。亚胺培南的耐药率在3年期间从63.2%升至90.9%。然而，在这60例AB-VAP病例中，四种抗生素联合在大多数情况下有效：舒巴坦联合依替米星的有效率为75%（18/24），舒巴坦联合左氧氟沙星的有效率为71.4%（10/14），美罗培南联合依替米星的有效率为72.7%（8/11），美罗培南联合左氧氟沙星的有效率为63.6%（7/11）。四种方案之间无统计学差异（P>0.05）。舒巴坦联合依替米星使舒巴坦的MIC降低了1/2，依替米星的MIC降低更明显。采用美罗培南联合左氧氟沙星或依替米星时，美罗培南的MIC降至单用该药时的1/2。至于舒巴坦或美罗培南联合左氧氟沙星，也使左氧氟沙星MIC降至单用该药时的1/2。FIC结果表明四种联合抗菌方案的效果为相加或无关。舒巴坦与依替米星联合时相加效应为63.89%。联合药敏试验可能有助于选择抗菌治疗方案。以舒巴坦或美罗培南为基础的治疗方案可作为治疗AB-VAP的替代方案。在中国湖北随州，舒巴坦联合依替米星被视为推荐方案。
