Cho Jun Yeun, Kim Hyung-Sook, Yang Hye-Joo, Lee Yeon Joo, Park Jong Sun, Yoon Ho Il, Kim Hong Bin, Yim Jae-Joon, Lee Jae-Ho, Lee Choon-Taek, Cho Young-Jae
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju-si 28644, Korea.
Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea.
J Clin Med. 2020 Feb 9;9(2):476. doi: 10.3390/jcm9020476.
Treatment of methicillin-resistant (MRSA) pneumonia in critically ill patients remains unsatisfactory. This pilot study aimed to evaluate the clinical outcomes of aerosolised vancomycin in addition to intravenous administration in this setting. This was a prospective, noncomparative, phase II trial. Patients receiving mechanical ventilation for >48 h in intensive care units (ICUs) were screened; those receiving intravenous vancomycin for MRSA pneumonia were enrolled. Patients received aerosolised vancomycin (250 mg every 12 h for five days) via a vibrating mesh nebuliser. The primary outcome was treatment success (clinical cure or improvement) at the conclusion of antibiotic treatment. Vancomycin concentrations were measured in bronchoalveolar lavage fluid according to administration time. Twenty patients were enrolled (median age 75 years and 13 (65%) men; 18 (90%) cases with nosocomial pneumonia). Thirteen patients (65%) showed clinical cure or improvement. Microbiological eradication of MRSA was confirmed in 14 patients (70%). ICU and hospital mortality rates were 30% and 35%, respectively. Maximum aerosolised vancomycin concentration was observed 4-5 h after nebulising (98.75 ± 21.79 mcg/mL). No additional systemic adverse effects occurred following aerosol vancomycin treatment. Aerosolised vancomycin combination therapy may be an alternative treatment for patients with severe MRSA pneumonia receiving mechanical ventilation (ClinicalTrials.gov number, NCT01925066).
重症患者耐甲氧西林金黄色葡萄球菌（MRSA）肺炎的治疗效果仍不尽人意。这项前瞻性试点研究旨在评估在这种情况下，雾化万古霉素联合静脉给药的临床疗效。这是一项前瞻性、非对照的II期试验。对在重症监护病房（ICU）接受机械通气超过48小时的患者进行筛查；纳入那些因MRSA肺炎接受静脉万古霉素治疗的患者。患者通过振动网孔雾化器接受雾化万古霉素治疗（每12小时250毫克，共五天）。主要结局是抗生素治疗结束时的治疗成功（临床治愈或改善）。根据给药时间测定支气管肺泡灌洗液中的万古霉素浓度。共纳入20例患者（中位年龄75岁，男性13例（65%）；18例（90%）为医院获得性肺炎）。13例患者（65%）临床治愈或改善。14例患者（70%）MRSA微生物学清除得到确认。ICU和医院死亡率分别为30%和35%。雾化后4 - 5小时观察到雾化万古霉素的最大浓度（98.75±21.79微克/毫升）。雾化万古霉素治疗后未出现额外的全身不良反应。雾化万古霉素联合治疗可能是接受机械通气的重症MRSA肺炎患者的一种替代治疗方法（ClinicalTrials.gov编号，NCT01925066）。
