多利培南与美罗培南治疗医院获得性肺炎和呼吸机相关性肺炎的疗效比较。

Comparative efficacy of doripenem versus meropenem for hospital-acquired and ventilator-associated pneumonia.

机构信息

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

J Microbiol Immunol Infect. 2019 Oct;52(5):788-795. doi: 10.1016/j.jmii.2019.04.008. Epub 2019 May 14.

DOI:10.1016/j.jmii.2019.04.008

PMID:31155463

Abstract

BACKGROUND

Doripenem shows good in vitro activity against common nosocomial pathogens, such as extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii. However, the use of doripenem for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) remains controversial. The aim of this study was to compare the efficacy and safety between doripenem and meropenem for patients with HAP or VAP.

METHODS

Adult patients diagnosed with HAP and VAP at National Taiwan University Hospital, who received doripenem or meropenem for more than 48 h between January 2015 and November 2017, were retrospectively reviewed. All-cause mortality on the 30th day was used as the primary outcome measurements.

RESULTS

Fifty-seven patients with doripenem and 252 patients with meropenem were analyzed. Compared to the meropenem group, the doripenem group was younger and had a higher Sequential Organ Failure Assessment (SOFA) score. Multivariable Cox regression analysis revealed that presence of solid organ malignancies (adjusted hazard ratio [AHR], 1.82; 95% CI, 1.04-3.19, p = 0.003) and SOFA score (AHR, 1.10; 95% CI, 1.03-1.17, p = 0.003) were independent factors associated with mortality. There was no survival difference of 30-day mortality between patients receiving doripenem and meropenem for HAP or VAP (log-rank p = 0.113). However, a poorer outcome was observed among patients with hematological disease in the doripenem group (log-rank p = 0.012).

CONCLUSION

Our results demonstrate that doripenem has similar efficacy as meropenem in HAP or VAP patients. With an aim to enhance antibiotic diversity, doripenem could be an alternative choice for patients with HAP or VAP, except for those with hematological malignancies.

摘要

背景

多利培南对常见医院获得性病原体具有良好的体外活性，如产超广谱β-内酰胺酶（ESBL）的肠杆菌科、铜绿假单胞菌和鲍曼不动杆菌。然而，多利培南在医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）中的应用仍存在争议。本研究旨在比较多利培南与美罗培南治疗 HAP 或 VAP 患者的疗效和安全性。

方法

回顾性分析 2015 年 1 月至 2017 年 11 月期间在国立台湾大学医院接受多利培南或美罗培南治疗超过 48 小时的 HAP 和 VAP 成人患者。以第 30 天的全因死亡率作为主要结局指标。

结果

共分析了 57 例多利培南组和 252 例美罗培南组患者。与美罗培南组相比，多利培南组患者年龄更小，序贯器官衰竭评估（SOFA）评分更高。多变量 Cox 回归分析显示，实体器官恶性肿瘤（调整危险比[HR]，1.82；95%置信区间[CI]，1.04-3.19，p=0.003）和 SOFA 评分（HR，1.10；95%CI，1.03-1.17，p=0.003）是与死亡率相关的独立因素。多利培南组和美罗培南组 HAP 或 VAP 患者 30 天死亡率无生存差异（对数秩检验 p=0.113）。然而，多利培南组血液系统疾病患者的预后较差（对数秩检验 p=0.012）。