辅助雾化硫酸黏菌素治疗多重耐药革兰氏阴性菌肺炎的疗效和安全性：一项回顾性对比队列研究。

Efficacy and safety of adjunctive nebulized colistin sulfate for multidrug-resistant Gram-negative bacteria pneumonia: a retrospective comparative cohort study.

机构信息

Department of Respiratory and Critical Care Medicine, Chongqing University Fuling Hospital, Chongqing, China.

Department of Pharmacy, Chongqing University Fuling Hospital, Chongqing, China.

出版信息

Ann Palliat Med. 2022 Sep;11(9):2939-2951. doi: 10.21037/apm-22-984.

DOI:10.21037/apm-22-984

PMID:36217623

Abstract

BACKGROUND

The incidence of multidrug-resistant Gram-negative bacteria (MDR-GNB) pneumonia has increased in the last decade. If antibiotics are given only through intravenous, the antibiotic concentrations in lung tissue will be insufficient. Recently, nebulized antibiotics have shown effectiveness as an adjunctive therapy with intravenous antibiotics for resistant strains. Therefore, the goal of this study was to assess the efficacy and safety of adjunctive nebulized colistin sulfate in combination with intravenous antibiotics in patients with MDR-GNB pneumonia.

METHODS

A total of 203 patients who were infected with MDR-GNB pneumonia were selected. Based on whether patients received nebulized colistin sulfate, patients were divided into 2 groups: the NCIA group (nebulized colistin sulfate in combination with intravenous antibiotics) and the IA group (intravenous antibiotics without nebulized colistin sulfate). After propensity score matching (PSM) analysis, we compared the efficacy in terms of favorable clinical outcomes, the bacteria detection rate, days of hospital stay, days of intensive care unit (ICU) stay, days of mechanical ventilation (MV), antipyretic time, days of antibiotic therapy, and 28-day all-cause mortality. Safety was also compared between groups.

RESULTS

A total of 116 patients met the criteria for evaluation, with 46 patients in the NCIA group and 70 patients in the IA group. After PSM, 31 patients were selected from each group. There were significant differences in favorable clinical outcomes on days 7 (67.7% vs. 32.3%, P=0.005) and 14 (71% vs. 41.9%, P=0.045) and the bacteria detection rate on days 7, 14, and the last day. There were also significant differences in days of hospital stay (17 vs. 23 days, P=0.01), antipyretic time (0.5 vs. 7.5 days, P=0.037), and days of antibiotic therapy (14 vs. 23 days, P=0.002). However, there were no significant differences in days of ICU stay, days of MV, and 28-day all-cause mortality. For nephrotoxicity, the NCIA group did not increase the risk of acute kidney injury (16.1% vs. 9.7%, P=0.707), only one patient (3.2%) in the NCIA group developed airway hyperresponsiveness (P=1.000).

CONCLUSIONS

For MDR-GNB pneumonia, nebulized colistin sulfate as an adjuvant supportive treatment for intravenous antibiotics maybe can improve clinical efficacy and has high safety.

摘要

背景

在过去的十年中，耐多药革兰氏阴性菌（MDR-GNB）肺炎的发病率有所增加。如果仅通过静脉给予抗生素，肺组织中的抗生素浓度将不足。最近，雾化抗生素已被证明可作为治疗耐药菌株的静脉抗生素的辅助治疗方法有效。因此，本研究的目的是评估附加使用硫酸粘菌素雾化吸入与静脉用抗生素联合治疗 MDR-GNB 肺炎患者的疗效和安全性。

方法

选择了 203 名患有 MDR-GNB 肺炎的患者。根据患者是否接受硫酸粘菌素雾化吸入，将患者分为 2 组：NCIA 组（硫酸粘菌素雾化吸入联合静脉用抗生素）和 IA 组（未用硫酸粘菌素雾化吸入的静脉用抗生素）。在进行倾向评分匹配（PSM）分析后，我们比较了两组患者在临床疗效、细菌检出率、住院天数、重症监护病房（ICU）住院天数、机械通气（MV）天数、退热时间、抗生素治疗天数和 28 天全因死亡率方面的差异。还比较了两组之间的安全性。

结果

共有 116 名患者符合评估标准，NCIA 组 46 例，IA 组 70 例。PSM 后，每组各选择 31 例患者。在第 7 天（67.7% vs. 32.3%，P=0.005）和第 14 天（71% vs. 41.9%，P=0.045）的临床疗效和第 7、14 天及最后一天的细菌检出率方面，差异均有统计学意义。住院天数（17 天 vs. 23 天，P=0.01）、退热时间（0.5 天 vs. 7.5 天，P=0.037）和抗生素治疗天数（14 天 vs. 23 天，P=0.002）也有显著差异。但是，ICU 住院天数、MV 天数和 28 天全因死亡率差异无统计学意义。对于肾毒性，NCIA 组并未增加急性肾损伤的风险（16.1% vs. 9.7%，P=0.707），仅 1 例（3.2%）NCIA 组患者发生气道高反应性（P=1.000）。