Xu Chenfeng, Zeng Fang, Xu Qiling, Yang Yu, Zhang Yu, Shi Chen
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Clinical Research Centre for Precision Medicine for Critical Illness, Wuhan, China.
Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Province Clinical Research Centre for Precision Medicine for Critical Illness, Wuhan, China.
Int J Antimicrob Agents. 2024 Dec;64(6):107334. doi: 10.1016/j.ijantimicag.2024.107334. Epub 2024 Sep 21.
To evaluate the therapeutic regimen, efficacy and safety of intrathecal or intraventricular (ITH/IVT) administration of polymyxin B for hospital-acquired central nervous system (CNS) infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB).
A retrospective study was undertaken of patients with CNS infections caused by CRAB treated with ITH/IVT combination therapy. The primary outcome was the clinical efficacy of treatment. The secondary outcomes were the bacterial clearance rate and the safety of therapy.
In total, 35 patients who received ITH [n=13 (37.1%)] or IVT [n=22 (62.9%)] polymyxin B as combination therapy were included in this study. The median duration of ITH/IVT polymyxin B therapy was 9 (interquartile range 7-11) days. The overall clinical cure rate and bacterial clearance rate were 77.1% and 85.7%, respectively. No adverse effects considered to be related to ITH/IVT polymyxin B were recorded. Clinical failure was independently associated with an Acute Physiology and Chronic Health Evaluation II score ≥15 [odds ratio (OR) 1.24, 95% confidence interval (CI) 1.05-1.42; P=0.038] and a Glasgow Coma Scale score ≤8 (OR 0.69, 95% CI 0.49-0.88; P=0.029). Early administration (≤4 days of infection onset) of ITH/IVT polymyxin B therapy resulted in a significantly higher clinical cure rate (OR 0.65, 95% CI 0.49-1.12; P<0.001), and may reduce the length of treatment and adverse effects.
ITH/IVT administration of polymyxin B is a valid alternative for the treatment of CNS infections caused by CRAB. Early use of ITH/IVT polymyxin B can result in greater clinical success.
评估鞘内或脑室内（ITH/IVT）注射多粘菌素B治疗耐碳青霉烯类鲍曼不动杆菌（CRAB）所致医院获得性中枢神经系统（CNS）感染的治疗方案、疗效及安全性。
对接受ITH/IVT联合治疗的CRAB所致CNS感染患者进行回顾性研究。主要结局为治疗的临床疗效。次要结局为细菌清除率及治疗安全性。
本研究共纳入35例接受ITH [n = 13（37.1%）]或IVT [n = 22（62.9%）]多粘菌素B联合治疗的患者。ITH/IVT多粘菌素B治疗的中位疗程为9（四分位间距7 - 11）天。总体临床治愈率和细菌清除率分别为77.1%和85.7%。未记录到被认为与ITH/IVT多粘菌素B相关的不良反应。临床治疗失败与急性生理与慢性健康状况评分系统II（APACHE II）评分≥15 [比值比（OR）1.24，95%置信区间（CI）1.05 - 1.42；P = 0.038]及格拉斯哥昏迷量表（GCS）评分≤8（OR 0.69，95% CI 0.49 - 0.88；P = 0.029）独立相关。ITH/IVT多粘菌素B治疗的早期给药（感染发作≤4天）导致临床治愈率显著更高（OR 0.65，95% CI 0.49 - 1.12；P < 0.001），且可能缩短治疗疗程及减少不良反应。
ITH/IVT注射多粘菌素B是治疗CRAB所致CNS感染的有效替代方案。早期使用ITH/IVT多粘菌素B可取得更大的临床成功。
