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基于四环素类药物方案治疗耐碳青霉烯类鲍曼不动杆菌菌血症患者的临床疗效:一项单中心回顾性队列研究。

Clinical Effectiveness of Tetracycline-Class Agents Based Regimens in Patients With Carbapenem-Resistant Bacteremia: A Single-Center Retrospective Cohort Study.

机构信息

Division of Infectious Diseases, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.

Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

J Korean Med Sci. 2023 Aug 28;38(34):e263. doi: 10.3346/jkms.2023.38.e263.

Abstract

This study evaluated the clinical outcome of carbapenem-resistant (CRAB) bacteremia and the clinical effectiveness of tetracyclines-based therapy. In a retrospective cohort study over 5 years period, 108 patients were included in the study. The overall 30-day mortality rate was 71.4%. Pitt's bacteremia score (PBS) (adjusted hazard ratio [aHR], 1.32; 95% confidence interval [CI], 1.22-1.42 per 1-point), colistin-single regimens (aHR, 0.34; 95% CI, 0.17-0.69), and tetracyclines single/tetracyclines-colistin combination regimens (aHR, 0.18; 95% CI, 0.07-0.48) were independently associated with 30-day mortality. Among patients with a PBS < 6, only tetracycline-containing regimens were associated with decreased mortality. Among patients receiving appropriate definite antimicrobials, the tetracyclines-colistin combination (7 of 7, 100%) tended to a higher 30-day survival rate compared to a tetracycline (7 of 12, 57.1%) or colistin single regimen (10 of 22, 41.6%, = 0.073). Our findings suggest tetracyclines might be effective for treating CRAB infections when combined with colistin.

摘要

本研究评估了耐碳青霉烯肠杆菌属(CRAB)菌血症的临床结局和基于四环素的治疗的临床疗效。在一项为期 5 年的回顾性队列研究中,纳入了 108 例患者。总的 30 天死亡率为 71.4%。皮氏菌血症评分(PBS)(校正后的危险比[aHR],每增加 1 分 1.32;95%置信区间[CI],1.22-1.42)、黏菌素单药治疗方案(aHR,0.34;95%CI,0.17-0.69)和四环素单药/四环素-黏菌素联合治疗方案(aHR,0.18;95%CI,0.07-0.48)与 30 天死亡率独立相关。在 PBS < 6 的患者中,只有含四环素的治疗方案与降低死亡率相关。在接受适当的明确抗菌药物治疗的患者中,四环素-黏菌素联合治疗方案(7/7,100%)的 30 天生存率较四环素(7/12,57.1%)或黏菌素单药治疗方案(10/22,41.6%,=0.073)有升高趋势。我们的研究结果表明,四环素与黏菌素联合使用可能对治疗 CRAB 感染有效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e3b/10462474/ee4d9a43c8b5/jkms-38-e263-g001.jpg

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