头孢他啶-阿维巴坦联合治疗产碳青霉烯酶肺炎克雷伯菌引起的医院获得性中枢神经系统感染。
Ceftazidime-avibactam-based combination therapy for hospital-acquired central nervous system infections caused by carbapenem-resistant Klebsiella pneumoniae.
机构信息
Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Clinical Pharmacology of Antibiotics, National Heath Commission, Shanghai, China; Institute of Microbes and Infections, Huashan Hospital, Fudan University, Shanghai, China.
Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, China.
出版信息
Int J Antimicrob Agents. 2023 May;61(5):106777. doi: 10.1016/j.ijantimicag.2023.106777. Epub 2023 Mar 9.
OBJECTIVES
Klebsiella pneumoniae (K. pneumoniae) is one of the most common bacteria in the hospital-acquired central nervous system (CNS) infections. Central nervous system infections caused by carbapenem-resistant K. pneumoniae (CRKP) are associated with significant mortality rates and high hospital costs due to limited antibiotic treatment options. This retrospective study aimed to evaluate the clinical efficacy of ceftazidime-avibactam (CZA) for the treatment of CNS infections caused by CRKP.
METHODS
Twenty-one patients with hospital-acquired CNS infections caused by CRKP who received treatment with CZA for ≥ 72 hours were enrolled. The primary outcome was to assess the clinical and microbiology efficacy of CZA for the treatment of CNS infections caused by CRKP.
RESULTS
A high burden of comorbidity was discovered in 20 of 21 patients (95.2%). Most patients had a history of craniocerebral surgery and 17 (81.0%) of the patients were in the intensive care unit with a median APACHE II score of 16 (IQR 9-20) and SOFA score of 6 (IQR 3-7). Eighteen cases were treated by CZA-based combination therapies, while the remaining three cases were treated with CZA alone. At the end of the treatment, the overall clinical efficacy was 76.2% (16 of 21) with a bacterial clearance rate of 81.0% (17 of 21) and all-cause mortality of 23.8% (five of 21).
CONCLUSION
This study showed that CZA-based combination therapy is an effective treatment option for CNS infections caused by CRKP.
目的
肺炎克雷伯菌（K. pneumoniae）是医院获得性中枢神经系统（CNS）感染中最常见的细菌之一。由于抗生素治疗选择有限，耐碳青霉烯类肺炎克雷伯菌（CRKP）引起的中枢神经系统感染与高死亡率和高医院成本相关。本回顾性研究旨在评估头孢他啶-阿维巴坦（CZA）治疗 CRKP 引起的中枢神经系统感染的临床疗效。
方法
纳入 21 例接受 CZA 治疗≥72 小时的医院获得性 CRKP 引起的中枢神经系统感染患者。主要结局是评估 CZA 治疗 CRKP 引起的中枢神经系统感染的临床和微生物学疗效。
结果
21 例患者中有 20 例（95.2%）存在严重的合并症。大多数患者有颅脑手术史，17 例（81.0%）患者在重症监护病房，中位急性生理学与慢性健康状况评分系统 II 评分 16（四分位距 9-20）和序贯器官衰竭评分 6（四分位距 3-7）。18 例采用 CZA 联合治疗，其余 3 例采用 CZA 单药治疗。治疗结束时，总体临床疗效为 76.2%（21 例中的 16 例），细菌清除率为 81.0%（21 例中的 17 例），总死亡率为 23.8%（21 例中的 5 例）。
结论
本研究表明，CZA 联合治疗是治疗 CRKP 引起的中枢神经系统感染的有效治疗选择。
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