Zha Lei, Zhang Xue, Cheng Yusheng, Xu Qiancheng, Liu Lingxi, Chen Simin, Lu Zhiwei, Guo Jun, Tefsen Boris
Department of Respiratory Medicine, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu 241000, China.
Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK.
Antibiotics (Basel). 2023 Jan 30;12(2):273. doi: 10.3390/antibiotics12020273.
Although the combination of polymyxin and tigecycline is widely used in treating carbapenem-resistant bacterial infections, the benefit of this combination is still uncertain. To assess whether adding polymyxin B to the high-dose tigecycline regimen would result in better clinical outcomes than the high-dose tigecycline therapy in patients with pneumonia caused by carbapenem-resistant and , we conducted a propensity score-matched cohort study in a single center between July 2019 and December 2021. Of the 162 eligible patients, 102 were included in the 1:1 matched cohort. The overall 14-day mortality in the matched cohort was 24.5%. Compared with high-dose tigecycline, the combination therapy was not associated with better clinical outcomes, and showed similar 14-day mortality (OR, 0.72, 95% CI 0.27-1.83, = 0.486), clinical cure (OR, 1.09, 95% CI 0.48-2.54, = 0.823), microbiological cure (OR, 0.96, 95% CI 0.39-2.53, = 0.928) and rate of nephrotoxicity (OR 0.85, 95% CI 0.36-1.99, = 0.712). Subgroup analyses also did not demonstrate any statistical differences. Based on these results, it is reasonable to recommend against adding polymyxin B to the high-dose tigecycline regimen in treating pneumonia caused by carbapenem-resistant and .
尽管多粘菌素和替加环素联合用药在治疗耐碳青霉烯类细菌感染中被广泛使用，但这种联合用药的益处仍不明确。为了评估在耐碳青霉烯类肺炎患者中，在高剂量替加环素治疗方案中添加多粘菌素B是否比高剂量替加环素单药治疗能带来更好的临床结局，我们于2019年7月至2021年12月在单中心开展了一项倾向评分匹配队列研究。在162例符合条件的患者中，102例被纳入1:1匹配队列。匹配队列的总体14天死亡率为24.5%。与高剂量替加环素相比，联合治疗并未带来更好的临床结局，且14天死亡率相似（比值比，0.72，95%置信区间0.27 - 1.83，P = 0.486），临床治愈率（比值比，1.09，95%置信区间0.48 - 2.54，P = 0.823），微生物清除率（比值比，0.96，95%置信区间0.39 - 2.53，P = 0.928）以及肾毒性发生率（比值比0.85，95%置信区间0.36 - 1.99，P = 0.712）。亚组分析也未显示出任何统计学差异。基于这些结果，不建议在耐碳青霉烯类肺炎患者的高剂量替加环素治疗方案中添加多粘菌素B。
