Chen Wenhui, Sun Lingxiao, Guo Lijuan, Cao Bin, Liu Yingmei, Zhao Li, Lu Binghuai, Li Binbin, Chen Jingyu, Wang Chen
Department of Lung Transplantation, Centre for Lung Transplantation, Centre for Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China.
China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Capital Medical University, Beijing 100029, China.
Ann Transl Med. 2020 Feb;8(3):39. doi: 10.21037/atm.2019.10.40.
Infections produced by extensively drug-resistant (XDR) gram-negative bacilli (GNB) in solid organ transplant (SOT) are an important cause of morbidity and mortality. Ceftazidime/avibactam (CAZ-AVI) is a novel β-lactam/β-lactamase combination antibiotic with anti-GNB activity, but experience in real clinical practice with CAZ-AVI in lung transplant (LT) recipients is limited.
We conducted a retrospective study of patients with XDR-GNB infection who received at least 3 days of CAZ-AVI in the Department of Lung Transplantation Between December 2017 and December 2018 at China-Japan friendship hospital (CJFH). The general information, clinical manifestations, laboratory examinations, treatment course, and outcomes were summarized.
A total of 10 patients who underwent LT at our center were included. They were all males with a mean age 51 years. Infections after LT included pneumonia and/or tracheobronchitis [n=9; 90% (9/10)], cholecystitis and blood stream infection (BSI) (n=1, patient 8). In these 10 LT recipients, the incidence of various airway complications was 70% (7/10). Carbapenem-resistant (CRKP) was the predominant pathogen, being detected in 9 patients. Multilocus sequence typing (MLST) analysis showed that all 9 CRKP isolates belonged to ST11. Six patients (6/10, 60%) started CAZ-AVI as salvage therapy after a first-line treatment with other antimicrobials. CAZ-AVI was administered as monotherapy or in combination regimens in 20% (2/10) and 80% (8/10) of patients respectively. There were no difference in temperature before and after CAZ-AVI treatment (P>0.05). White blood cell (WBC) at 7 days, and procalcitonin (PCT) at 7 days and 14 days significantly dropped (P<0.05). After 7-14 days of CAZ-AVI treatment, the PaO/FiOratio (P/F ratio) significantly improved (P<0.05). Nine patients (9/10, 90%) obtained negative microbiologic culture of CRKP/CRPA, with a median time to was 6.7 days (range, 1-15 days). However, 5 patients (5/10, 50%) had relapse of CRKP/CRPA infections in the respiratory tract regardless of whether negative microbiologic culture was obtained or not. The 30-day survival rate was 100%, and the 90-day survival rate was 90% (1/10). No severe adverse events related to CAZ-AVI occurred.
CAZ-AVI treatment of CRKP/ CRPA infection in LT recipients was associated with high rates of clinical success, survival, and safety, but recurrent CRKP/CRPA infections in the respiratory tract did occur.
实体器官移植（SOT）中由广泛耐药（XDR）革兰氏阴性杆菌（GNB）引起的感染是发病和死亡的重要原因。头孢他啶/阿维巴坦（CAZ - AVI）是一种新型的β - 内酰胺/β - 内酰胺酶联合抗生素，具有抗GNB活性，但在肺移植（LT）受者的实际临床应用经验有限。
我们对2017年12月至2018年12月在中国 - 日本友好医院（CJFH）肺移植科接受至少3天CAZ - AVI治疗的XDR - GNB感染患者进行了一项回顾性研究。总结了患者的一般信息、临床表现、实验室检查、治疗过程和结局。
我们中心共有10例接受LT的患者纳入研究。他们均为男性，平均年龄51岁。LT后的感染包括肺炎和/或气管支气管炎[n = 9；90%（9/10）]、胆囊炎和血流感染（BSI）（n = 1，患者8）。在这10例LT受者中，各种气道并发症的发生率为70%（7/10）。耐碳青霉烯肺炎克雷伯菌（CRKP）是主要病原体，在9例患者中检测到。多位点序列分型（MLST）分析显示，所有9株CRKP分离株均属于ST11。6例患者（6/10，60%）在一线使用其他抗菌药物治疗后开始使用CAZ - AVI作为挽救治疗。CAZ - AVI分别以单药治疗或联合治疗方案给药的患者比例为20%（2/10）和80%（8/10）。CAZ - AVI治疗前后体温无差异（P>0.05）。第7天的白细胞（WBC）以及第7天和第14天的降钙素原（PCT）显著下降（P<0.05）。CAZ - AVI治疗7 - 14天后，氧合指数（PaO/FiO）显著改善（P<0.05）。9例患者（9/10，90%）CRKP/CRPA微生物培养转为阴性，中位转阴时间为6.7天（范围1 - 15天）。然而，5例患者（5/10，50%）无论是否获得微生物培养阴性结果，呼吸道CRKP/CRPA感染均有复发。30天生存率为100%，90天生存率为90%（1/10）。未发生与CAZ - AVI相关的严重不良事件。
CAZ - AVI治疗LT受者的CRKP/CRPA感染临床成功率、生存率和安全性较高，但呼吸道CRKP/CRPA感染确实会复发。
