Hasan Md Jahidul, Rabbani Raihan, Anam Ahmad Mursel, Santini Ario, Huq Shihan Mahmud Redwanul
Clinical Pharmacy Services, Square Hospitals Ltd., Dhaka, Bangladesh.
ICU and Internal Medicine, Square Hospitals Ltd., Dhaka, Bangladesh.
J Crit Care Med (Targu Mures). 2021 Jan 29;7(1):28-36. doi: 10.2478/jccm-2020-0044. eCollection 2021 Jan.
Critically ill patients in intensive care units are at high risk of dying not only from the severity of their illness but also from secondary causes such as hospital-acquired infections. USA national medical record-data show that approximately 10% of patients on mechanical ventilation in an intensive care unit developed ventilator-associated pneumonia. Polymyxin B has been used intravenously in the treatment of multi-drug resistant gram-negative infections, either as a monotherapy or with other potentially effective antibiotics, and the recent international guidelines have emphasised the use of nebulised polymyxin B together with intravenous polymyxin B to gain the optimum clinical outcome in ventilator-associated pneumonia cases caused by multi-drug resistant gram-negative infections.
One hundred and seventy-eight patients with ventilator-associated pneumonia due to multi-drug resistant were identified during the study period. Following the inclusion and exclusion criteria, 121 patients were enrolled in the study and randomly allocated to two study groups. Group 1 patients were treated with intravenous Polymyxin B plus nebulised polymyxin B (n=64) and Group 2 patients with intravenous Polymyxin B alone (n=57). The study aimed to compare the use of Polymyxin B plus its nebulised form to polymyxin B alone, in the treatment of MDR- associated ventilator-associated pneumonia in critically ill patients.
In Group 1, a complete clearance of was found in fifty-nine patients (92.1%; n=64) compared to forty patients (70.1%, n=57) in the Group 2 (P<0.003). The average time till extubation was significantly higher in Group 2 compared to Group 1 (P<0.05). The total length-of-stay in the ICU was significantly higher in Group 2 compared to Group 1. (P<0.05). These results support the view that the Polymyxin B dual-route regime may be considered as an appropriate antibiotic therapy, in critically ill South Asian patients with ventilator-associated pneumonia.
重症监护病房中的重症患者不仅面临因病情严重程度导致的高死亡风险，还面临诸如医院获得性感染等继发原因带来的风险。美国国家医疗记录数据显示，重症监护病房中接受机械通气的患者约有10%发生了呼吸机相关性肺炎。多黏菌素B已被用于静脉治疗多重耐药革兰氏阴性菌感染，可作为单一疗法或与其他潜在有效的抗生素联合使用，最近的国际指南强调雾化多黏菌素B与静脉注射多黏菌素B联合使用，以在由多重耐药革兰氏阴性菌感染引起的呼吸机相关性肺炎病例中获得最佳临床效果。
在研究期间确定了178例因多重耐药导致呼吸机相关性肺炎的患者。按照纳入和排除标准，121例患者被纳入研究并随机分为两个研究组。第1组患者接受静脉注射多黏菌素B加雾化多黏菌素B治疗（n = 64），第2组患者仅接受静脉注射多黏菌素B治疗（n = 57）。该研究旨在比较多黏菌素B及其雾化形式与单独使用多黏菌素B在治疗重症患者多重耐药相关呼吸机相关性肺炎中的效果。
在第1组中，59例患者（92.1%；n = 64）实现了完全清除，而第2组为40例患者（70.1%，n = 57）（P < 0.003）。与第1组相比，第2组的平均拔管时间明显更长（P < 0.05）。第2组在重症监护病房的总住院时间明显长于第1组（P < 0.05）。这些结果支持这样一种观点，即对于患有呼吸机相关性肺炎的南亚重症患者，多黏菌素B双途径给药方案可被视为一种合适的抗生素治疗方法。
