Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital at Kee-Lung, Kee-Lung, Taiwan.
Department of Laboratory Medicine, Chang Gung Memorial Hospital at Kee-Lung, Kee-Lung, Taiwan.
J Microbiol Immunol Infect. 2020 Dec;53(6):854-865. doi: 10.1016/j.jmii.2019.08.007. Epub 2019 Sep 30.
To investigate clinical and microbiological response, and 30-day mortality of pneumonia involving multidrug-resistant (MDR) Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex treated with colistin, and identify associated factors of these outcomes.
A retrospective study of 183 adult patients with colistin treatment for at least 7 days between January 2014 and October 2017.
The mean age was 76.8 years, and mean Acute Physiology and Chronic Health Evaluation II score was 17.7. Eighteen (9.8%) and 128 (69.9%) patients had intravenous (IV) colistin alone and inhaled (IH) colistin alone, respectively. Thirty-seven patients had both IV and IH colistin, including 5 (2.7%) with concurrent, and 32 (17.5%) with non-concurrent use of IV and IH colistin. The 30-day mortality rate was 19.1% and 131 (71.6%) patients had clinical response. In the 175 patients with available data, 126 (72%) had microbiological eradication. The multivariate analyses revealed that IH colistin alone was an independent predictor for 30-day survival, clinical response, and microbiological eradication, and IV colistin alone was an independent predictor for clinical failure. Patients with IV colistin alone had a significantly higher nephrotoxicity rate than IH colistin alone (37.5% vs 6.1%, P = 0.001). Sub-group analysis of 52 patients with IV colistin for ≧ 4 days revealed that 14 (26.9%) patients had inappropriate dose, and inappropriate dose was an independent predictor for 30-day mortality.
IH colistin provided good outcomes with few side effects, and appropriate dosing of IV colistin was important to avoid excess mortality.
研究涉及耐多药（MDR）鲍曼不动杆菌-醋酸钙不动杆菌（Acb）复合体肺炎患者使用黏菌素治疗的临床和微生物学反应及 30 天死亡率，并确定这些结果的相关因素。
回顾性分析 2014 年 1 月至 2017 年 10 月期间至少接受 7 天黏菌素治疗的 183 例成年患者。
患者平均年龄为 76.8 岁，平均急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分为 17.7。18 例（9.8%）和 128 例（69.9%）患者分别单独接受静脉（IV）黏菌素和吸入（IH）黏菌素治疗。37 例患者同时接受 IV 和 IH 黏菌素治疗，其中 5 例（2.7%）为同时使用，32 例（17.5%）为非同时使用。30 天死亡率为 19.1%，131 例（71.6%）患者临床症状改善。在 175 例可获得数据的患者中，126 例（72%）微生物学清除。多变量分析显示，单独 IH 黏菌素是 30 天生存、临床反应和微生物学清除的独立预测因素，而单独 IV 黏菌素是临床失败的独立预测因素。单独 IV 黏菌素治疗的患者肾毒性发生率明显高于单独 IH 黏菌素治疗（37.5%比 6.1%，P=0.001）。对 52 例接受 IV 黏菌素治疗≥4 天的患者进行亚组分析显示，14 例（26.9%）患者剂量不合适，剂量不合适是 30 天死亡的独立预测因素。
IH 黏菌素治疗效果好，副作用少，IV 黏菌素的适当剂量对于避免死亡率过高很重要。
