Hasan Md Jahidul, Sumi Chandra Datta, Huq Shihan Mahmud Redwanul, Anam Ahmad Mursel, Rabbani Raihan
University of New South Wales, Sydney, NSW, Australia.
The University of Queensland, Brisbane, Australia.
J Crit Care Med (Targu Mures). 2023 May 8;9(2):106-115. doi: 10.2478/jccm-2023-0012. eCollection 2023 Apr.
Pandrug-resistant Klebsiella pneumoniae ventilator associated pneumonia (VAP) is associated with high rate of mortality in intensive care unit (ICU) and has been recognized as a difficult-to-treat infection worldwide. Polymyxin B or colistin-based combination therapies are frequently used worldwide though microbial eradication rate is not promising.
The aim of this study is to compare the clinical outcome of intravenous with aerosolized polymyxin B versus colistin in the treatment of pandrug-resistant K. pneumoniae VAP.
This retrospective cohort study was conducted on 222 mechanically ventilated patients admitted from May 11, 2019 to October 19, 2020. K. pneumoniae isolates were resistant to all available antibiotics, including polymyxins in culture sensitivity tests. As treatment, polymyxin B and colistin was administered in intravenous and aerosolized form concurrently twice daily in 106 patients and 116 patients in PMB and CLN group, respectively for 14 days. Survival rate, safety, and clinical outcomes were compared among the groups. The Cox proportional-hazard model was performed to calculate hazard ratio (HR) with 95% confidence intervals (CI).
Patients in PMB group showed more microbial eradication than the patients CLN group [68.1% (n=116)/83% (n=106), respectively; P <0.05). The median day of intubation and ICU stay in PMB group was shorter than that in CLN group [10 (IQR: 9-12.25) vs. 14 (IQR: 11-19), P <0.05; 12 (IQR: 10-14) vs. 15 (IQR: 9-18.5), P=0.072, respectively] with reduced 60-day all-cause mortality rate [15% (n=106) vs. 21.55% (n=116)]. Polymyxin B improved survival compared to colistin (multivariate HR: 0.662; 95% CI=0.359-1.222, P=0.195).
Concurrent administration of intravenous and aerosolized polymyxin B in patients with pandrug-resistant K. pneumoniae-associated VAP revealed better microbial eradication, reduced the length of intubation and ICU stay, and improved survival rate compared to colistin.
泛耐药肺炎克雷伯菌呼吸机相关性肺炎（VAP）与重症监护病房（ICU）的高死亡率相关，并且在全球范围内已被公认为是一种难以治疗的感染。尽管微生物清除率不尽人意，但基于多粘菌素B或粘菌素的联合疗法在全球范围内仍被频繁使用。
本研究的目的是比较静脉注射联合雾化吸入多粘菌素B与粘菌素治疗泛耐药肺炎克雷伯菌VAP的临床疗效。
本回顾性队列研究对2019年5月11日至2020年10月19日收治的222例机械通气患者进行。肺炎克雷伯菌分离株对所有可用抗生素耐药，包括在培养敏感性试验中对多粘菌素耐药。作为治疗方法，多粘菌素B组106例患者和粘菌素组116例患者分别每天两次同时静脉注射和雾化吸入多粘菌素B和粘菌素，持续14天。比较各组的生存率、安全性和临床结局。采用Cox比例风险模型计算风险比（HR）及95%置信区间（CI）。
多粘菌素B组患者的微生物清除情况优于粘菌素组[分别为68.1%（n = 116）/83%（n = 106）；P < 0.05]。多粘菌素B组的插管中位天数和ICU住院时间短于粘菌素组[分别为10（IQR：9 - 12.25）天对14（IQR：11 - 19）天，P < 0.05；12（IQR：10 - 14）天对15（IQR：9 - 18.5）天，P = 0.072]，60天全因死亡率降低[15%（n = 106）对21.55%（n = 116）]。与粘菌素相比，多粘菌素B提高了生存率（多变量HR：0.662；95%CI = 0.359 - 1.222，P = 0.195）。
对于泛耐药肺炎克雷伯菌相关VAP患者，静脉注射联合雾化吸入多粘菌素B与粘菌素相比，显示出更好的微生物清除效果，缩短了插管时间和ICU住院时间，并提高了生存率。
