头孢他啶-阿维巴坦治疗革兰阴性菌医院获得性肺炎的有效性：印度的一项真实世界研究。
Effectiveness of Ceftazidime-Avibactam in Gram-Negative Nosocomial Pneumonia: A Real-World Study in India.
作者信息
Gupta Neha, Saseedharan Sanjith, Paliwal Yashesh
机构信息
Internal Medicine and Infectious Diseases, Fortis Memorial Research Institute, Gurugram, IND.
Critical Care, SL Raheja Hospital - A Fortis Associate, Mumbai, IND.
出版信息
Cureus. 2024 Feb 19;16(2):e54443. doi: 10.7759/cureus.54443. eCollection 2024 Feb.
BACKGROUND AND OBJECTIVE
The incidences of nosocomial pneumonia in intensive care units (ICUs) in India have been reported to range from 9% to 58% and are associated with a mortality rate of 30-70%. Ceftazidime-avibactam has activity against OXA-48-like carbapenem-resistant (CRE) and has a safer adverse effect profile as compared to the nephrotoxic colistin. The current study aimed to assess the effectiveness and usage pattern of ceftazidime-avibactam in gram-negative hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in real-world settings in India.
METHODS
Electronic medical records of hospitalized patients in three prominent medical centers in India (Fortis Memorial Research Centre, Gurugram, S L Raheja Hospital, Mumbai, and Fortis Hospital, Anandapur, Kolkata) with nosocomial pneumonia and documented gram-negative (KP)confirmed infection were collected. This study assessed the effectiveness, usage pattern of ceftazidime-avibactam, and clinical and microbiological cure rates.
RESULTS
Among the 116 patients included, 78.45% (91/116) showed clinical cure. Microbiological cure was observed in nine out of 13 (69.23%) patients. In the subset analysis, a clinical cure rate of 84.85% (28/33) and microbiological recovery rate of 62.50% (5/8) were observed when ceftazidime-avibactam was initiated within 72 hours of diagnosis. Ceftazidime-avibactam was administered for a mean (±SD) duration of 7.79 ± 4.43 days, with improvement in signs and symptoms reported among 91.38% (106/116). Ceftazidime-avibactam showed a susceptibility of 56% (28/56) in the study.
CONCLUSION
The current study showed a better clinical and microbiological cure rate with a safer tolerability profile of ceftazidime-avibactam in carbapenem-resistant KP nosocomial pneumonia and VAP. This study has further demonstrated that ceftazidime-avibactam may be used as one of the viable treatment choices in carbapenem-resistant KP with favorable clinical outcomes.
背景与目的
据报道，印度重症监护病房（ICU）医院获得性肺炎的发病率在9%至58%之间，死亡率为30%-70%。头孢他啶-阿维巴坦对OXA-48样耐碳青霉烯肠杆菌科细菌（CRE）有活性，与具有肾毒性的黏菌素相比，其不良反应谱更安全。本研究旨在评估头孢他啶-阿维巴坦在印度实际临床环境中治疗革兰氏阴性医院获得性肺炎（HAP）和呼吸机相关性肺炎（VAP）的有效性及使用模式。
方法
收集了印度三个著名医疗中心（古尔冈的富通纪念研究中心、孟买的SL拉贾医院和加尔各答的阿南德布尔富通医院）住院的医院获得性肺炎患者且有革兰氏阴性（肺炎克雷伯菌）确诊感染的电子病历。本研究评估了头孢他啶-阿维巴坦的有效性、使用模式以及临床和微生物学治愈率。
结果
在纳入的116例患者中，78.45%（91/116）显示临床治愈。13例患者中有9例（69.23%）观察到微生物学治愈。在亚组分析中，在诊断后72小时内开始使用头孢他啶-阿维巴坦时，临床治愈率为84.85%（28/33），微生物学恢复率为62.50%（5/8）。头孢他啶-阿维巴坦的平均（±标准差）给药持续时间为7.79±4.43天，91.38%（106/116）的患者报告症状和体征有所改善。在该研究中，头孢他啶-阿维巴坦的敏感性为56%（28/56）。
结论
本研究表明，在耐碳青霉烯肺炎克雷伯菌医院获得性肺炎和VAP中，头孢他啶-阿维巴坦具有更好的临床和微生物学治愈率，耐受性更安全。本研究进一步证明，头孢他啶-阿维巴坦可作为耐碳青霉烯肺炎克雷伯菌感染的可行治疗选择之一，具有良好的临床效果。
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