Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clin Respir J. 2023 Apr;17(4):295-302. doi: 10.1111/crj.13594. Epub 2023 Feb 12.
Although investigations are limited, adjunctive aerosolized antibiotics have been advised in the setting of gram-negative ventilator-associated pneumonia (VAP). This study aimed to compare the efficiency of inhaled colistin with inhaled fosfomycin/tobramycin in treating VAP due to extensively drug-resistant (XDR) Acinetobacter baumannii.
This single center open-label randomized controlled trial included 60 patients who developed XDR A. bumannii VAP. Eligible participants were randomly assigned to two groups (no. 30). Regardless of the assignment, all participants received meropenem (2 g as a 3-h extended infusion every 8 h) plus intravenous colistin (a loading dose of 9 million IU and then 4.5 million IU every 12 h). The control group was given inhaled colistin (1 million IU every 8 h), and the case group received inhaled tobramycin/fosfomycin (300 mg every 12 h/80 mg every 12 h) as adjunctive therapy. The primary outcome was treatment duration, and the secondary outcomes were Clinical Pulmonary Infection Score (CPIS) trend and mortality rate in the groups. The decision to stop treatment was made by the treating physician.
The mean treatment duration was 13.73 ± 3.22 days in the colistin group and 10.85 ± 2.84 days in the tobramycin/fosfomycin group; the mean treatment duration in the latter group was lower significantly (P = 0.001). CPIS was decreased in the groups significantly (P < 0.001), but the mean changes of CPIS were significantly different between the groups, and in the inhaled tobramycin/fosfomycin group, a greater reduction (P = 0.005) was observed. Two (6.67%) patients in the control group and three (10%) patients in the case group died.
The use of inhaled tobramycin/fosfomycin in cases with XDR A. bumannii VAP was associated with a shorter treatment duration in this open-label trial.
尽管研究有限，但在革兰氏阴性呼吸机相关性肺炎（VAP）的情况下，已建议使用辅助雾化抗生素。本研究旨在比较吸入黏菌素与吸入磷霉素/妥布霉素治疗广泛耐药（XDR）鲍曼不动杆菌 VAP 的疗效。
这项单中心开放标签随机对照试验纳入了 60 名发生 XDR 鲍曼不动杆菌 VAP 的患者。符合条件的参与者被随机分为两组（每组 30 名）。无论分组如何，所有参与者均接受美罗培南（2 g 作为 3 小时延长输注，每 8 小时 1 次）加静脉注射黏菌素（负荷剂量 900 万 IU，然后每 12 小时 450 万 IU）。对照组给予吸入黏菌素（每 8 小时 100 万 IU），病例组给予吸入妥布霉素/磷霉素（每 12 小时 300 mg/每 12 小时 80 mg）作为辅助治疗。主要结局是治疗持续时间，次要结局是两组的临床肺部感染评分（CPIS）趋势和死亡率。停止治疗的决定由治疗医生做出。
黏菌素组的平均治疗时间为 13.73 ± 3.22 天，妥布霉素/磷霉素组为 10.85 ± 2.84 天；后者的平均治疗时间明显较低（P = 0.001）。两组 CPIS 均显著降低（P < 0.001），但两组 CPIS 的平均变化有显著差异，在吸入妥布霉素/磷霉素组观察到更大的降低（P = 0.005）。对照组有 2 名（6.67%）患者和病例组有 3 名（10%）患者死亡。
在这项开放标签试验中，XDR 鲍曼不动杆菌 VAP 患者使用吸入妥布霉素/磷霉素与较短的治疗时间相关。
