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