Division of Infectious Diseases, Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines.
Division of Infectious Diseases, Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines.
Diagn Microbiol Infect Dis. 2024 Nov;110(3):116481. doi: 10.1016/j.diagmicrobio.2024.116481. Epub 2024 Aug 6.
We compared clinical outcomes of patients who received monotherapy and combination therapy for treatment of MDR A. baumannii VAP. 170 patients were included. Vasopressor use and mortality rate were higher for combination therapy (69.3% versus 28.6%, p=0.024; 67.5% versus 14.3%, p=0.007; respectively). Majority received polymyxin B-based combination therapy, with higher mortality than those without polymyxin B (80.2% versus 19.8%, p=0.043). After adjusting for vasopressor use, monotherapy, dual combination, and triple combination therapy were not associated with mortality (aHR 0.24, 95% CI 0.03 to 1.79, p=0.169; aHR 1.26, 95% CI 0.79 to 2.00, p=0.367; aHR 0.93, 95% CI 0.57 to 1.49, p=0.744; respectively). There was no difference in adverse effects and length of stay between the two groups. Mortality from MDR A. baumannii VAP was high and not associated with monotherapy or combination therapy after adjustment for vasopressor use. Antibiotic regimens other than those containing polymyxin are urgently needed for the treatment of these infections.
我们比较了接受单药治疗和联合治疗的 MDR A. baumannii VAP 患者的临床结局。共纳入 170 例患者。联合治疗组血管加压素使用率和死亡率更高（69.3%比 28.6%，p=0.024；67.5%比 14.3%，p=0.007）。大多数患者接受了多粘菌素 B 为基础的联合治疗，死亡率高于未使用多粘菌素 B 的患者（80.2%比 19.8%，p=0.043）。调整血管加压素使用后，单药治疗、双联联合治疗和三联联合治疗与死亡率无关（aHR 0.24，95%CI 0.03 至 1.79，p=0.169；aHR 1.26，95%CI 0.79 至 2.00，p=0.367；aHR 0.93，95%CI 0.57 至 1.49，p=0.744）。两组之间的不良反应和住院时间无差异。在调整血管加压素使用后，MDR A. baumannii VAP 的死亡率较高，与单药或联合治疗无关。对于这些感染的治疗，迫切需要除多粘菌素以外的抗生素方案。
