Abany College of Pharmacy Health Sciences, Albany, New York, USA.
Merck & Co., Inc., Kenilworth, New Jersey, USA.
Pharmacotherapy. 2021 Aug;41(8):658-667. doi: 10.1002/phar.2600. Epub 2021 Jul 5.
The most commonly prescribed antibiotics for patients with hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) due to Pseudomonas aeruginosa are the conventional anti-pseudomonal β-lactams (APBLs) (ie, ceftazidime, cefepime, meropenem, or piperacillin-tazobactam). Similar resistance mechanisms in P. aeruginosa affect the APBLs, and it is unclear if resistance to one APBL can affect the effectiveness of other APBLs. This exploratory, hypothesis-generating analysis evaluates the impact of APBL resistance among patients in the intensive care unit (ICU) with P. aeruginosa HABP/VABP who initially receive a microbiologically active APBL.
A retrospective cohort [GJ1] [LT2] study.
Kaiser Permanente Southern California members (01/01/2011-12/31/2017).
The study included adult patients admitted to the ICU with a monomicrobial P. aeruginosa HABP/VABP who received a microbiologically active APBL within 2 days of index P. aeruginosa respiratory culture.
Patients were stratified by presence of resistance to APBL on index P. aeruginosa (0 vs. ≥1 resistant APBL).
Primary outcomes were 30-day mortality and discharge to home.
Overall, 553 patients were included. Thirty-day mortality was 28%, and 32% of patients were discharged home. Eighty-eight patients (16%) had a P. aeruginosa HABP/VABP that was resistant to ≥1 APBL (other than active empiric treatment). Relative to patients with no APBL resistance, patients with resistance to ≥1 APBL had a higher 30-day mortality (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.65 [1.02-2.66]) and were less likely to be discharged home (adjusted hazard ratio (aHR) [95% CI]: 0.50 [0.29-0.85]).
Further study is needed, but this exploratory analysis suggests that the full APBL susceptibility profile should be considered when selecting therapy for patients with P. aeruginosa HABP/VABP.
由于铜绿假单胞菌导致的医院获得性细菌性肺炎（HABP）和呼吸机相关性细菌性肺炎（VABP），最常开给患者的抗生素是传统抗假单胞菌β-内酰胺类药物（APBLs）（即头孢他啶、头孢吡肟、美罗培南或哌拉西林他唑巴坦）。铜绿假单胞菌中相似的耐药机制会影响 APBLs，尚不清楚对一种 APBL 的耐药是否会影响其他 APBL 的疗效。本探索性、产生假说的分析评估了在 ICU 中接受最初接受一种具有微生物学活性的 APBL 的铜绿假单胞菌 HABP/VABP 患者中 APBL 耐药的影响。
回顾性队列[GJ1][LT2]研究。
凯撒永久南加州会员（2011 年 1 月 1 日至 2017 年 12 月 31 日）。
研究纳入 ICU 中接受单一致病菌铜绿假单胞菌 HABP/VABP 治疗的成年患者，在索引铜绿假单胞菌呼吸道培养后 2 天内接受一种具有微生物学活性的 APBL。
患者根据指数铜绿假单胞菌中是否存在 APBL 耐药情况分层（0 vs. ≥1 种耐药 APBL）。
主要结局为 30 天死亡率和出院回家。
总体上，纳入了 553 名患者。30 天死亡率为 28%，32%的患者出院回家。88 名患者（16%）患有 1 种或多种 APBL 耐药（非活性经验性治疗）的铜绿假单胞菌 HABP/VABP。与无 APBL 耐药的患者相比，有 ≥1 种 APBL 耐药的患者 30 天死亡率更高（校正比值比[aOR] [95%置信区间（CI）]：1.65 [1.02-2.66]），出院回家的可能性更低（校正风险比[aHR] [95% CI]：0.50 [0.29-0.85]）。
需要进一步研究，但本探索性分析表明，在为铜绿假单胞菌 HABP/VABP 患者选择治疗方案时，应考虑完整的 APBL 药敏谱。
