Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy.
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy.
Int J Antimicrob Agents. 2024 Jul;64(1):107190. doi: 10.1016/j.ijantimicag.2024.107190. Epub 2024 Apr 30.
Severe infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) have been reported increasingly over the past few years. Many in-vivo and in-vitro studies have suggested a possible role of intravenous fosfomycin for the treatment of CRAB infections.
This multi-centre, retrospective study included patients treated with intravenous fosfomycin for severe infections caused by CRAB admitted consecutively to four hospitals in Italy from December 2017 to December 2022. The primary goal of the study was to evaluate the risk factors associated with 30-day mortality in the study population. A propensity score matched analysis was added to the model.
One hundred and two patients with severe infections caused by CRAB treated with an intravenous fosfomycin-containing regimen were enrolled in this study. Ventilator-associated pneumonia (VAP) was diagnosed in 59% of patients, primary bacteraemia in 22% of patients, and central-venous-catheter-related infection in 16% of patients. All patients were treated with a regimen containing intravenous fosfomycin, mainly in combination with cefiderocol (n=54), colistin (n=48) or ampicillin/sulbactam (n=18). Forty-eight (47%) patients died within 30 days. Fifty-eight (57%) patients experienced clinical therapeutic failure. Cox regression analysis showed that diabetes, primary bacteraemia and a colistin-containing regimen were independently associated with 30-day mortality, whereas adequate source control of infection, early 24-h active in-vitro therapy, and a cefiderocol-containing regimen were associated with survival. A colistin-based regimen, A. baumannii colonization and primary bacteraemia were independently associated with clinical failure. Conversely, adequate source control of infection, a cefiderocol-containing regimen, and early 24-h active in-vitro therapy were associated with clinical success.
Different antibiotic regimens containing fosfomycin in combination can be used for treatment of severe infections caused by CRAB.
近年来，碳青霉烯类耐药鲍曼不动杆菌（CRAB）引起的严重感染报道日益增多。许多体内和体外研究表明，磷霉素静脉给药可能对治疗 CRAB 感染有一定作用。
本多中心回顾性研究纳入了 2017 年 12 月至 2022 年 12 月期间，意大利四家医院连续收治的 102 例因 CRAB 引起的严重感染患者，给予静脉注射磷霉素治疗。本研究的主要目的是评估研究人群中与 30 天死亡率相关的危险因素。模型中增加了倾向评分匹配分析。
本研究共纳入 102 例因 CRAB 引起的严重感染患者，接受了含有磷霉素的静脉给药方案治疗。59%的患者诊断为呼吸机相关性肺炎（VAP），22%的患者诊断为原发性菌血症，16%的患者诊断为中心静脉导管相关感染。所有患者均接受了含有磷霉素的治疗方案，主要与头孢地尔（n=54）、黏菌素（n=48）或氨苄西林/舒巴坦（n=18）联合使用。48（47%）例患者在 30 天内死亡。58（57%）例患者出现临床治疗失败。Cox 回归分析显示，糖尿病、原发性菌血症和含黏菌素的治疗方案与 30 天死亡率独立相关，而感染源的充分控制、24 小时内早期积极的体外治疗和含头孢地尔的治疗方案与生存相关。含黏菌素的治疗方案、鲍曼不动杆菌定植和原发性菌血症与临床失败独立相关。相反，感染源的充分控制、含头孢地尔的治疗方案和 24 小时内早期积极的体外治疗与临床成功相关。
不同含磷霉素的抗生素方案联合使用可治疗 CRAB 引起的严重感染。
