Chaudhary Monika, Kumar Deepak, Meena Durga Shankar, Midha Naresh Kumar, Bohra Gopal Krishana, Tak Vibhor, Samantaray Subhashree, Kaur Navneet, Neetha T R, Mohammed Sadik, Sharma Ankur, Kothari Nikhil, Bhatia Pradeep Kumar, Garg M K
Division of Infectious Diseases, Department of General Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Indian J Med Microbiol. 2024 Nov-Dec;52:100737. doi: 10.1016/j.ijmmb.2024.100737. Epub 2024 Oct 3.
Carbapenem-resistant Acinetobacter baumannii (CRAB) is a common cause of ventilator-associated pneumonia (VAP). Some in vitro data favour various combination antibiotic therapy. However, there is a need for more in vivo studies for the management of VAP caused by CRAB. This retrospective study was done to evaluate the effectiveness of various combination antibiotic therapy including sulbactam on outcomes of VAP caused by CRAB.
Adult patients (age ≥18 years) diagnosed with VAP caused by CRAB were included. Patients with polymicrobial infections were excluded from the study. Patients with CRAB associated VAP who were given sulbactam based antibiotic combinations were observed for outcomes. The primary outcome was 28-day mortality after diagnosis of VAP caused by CRAB. Reduction in serum HsCRP (High sensitivity C-reactive protein) during treatment and requirement of inotropes were the secondary outcomes. Outcomes were compared between various sulbactam based antibiotic combination therapies.
A total of 103 patients were included. A total of 44 (42.7 %) patients received sulbactam and minocycline or sulbactam and polymyxin B dual antibiotic combination, and 59 (57.3 %) patients received sulbactam, polymyxin B and minocycline triple antibiotic combination. The percentage difference in 28 days mortality was 27.51 % (95 % CI 8.03 %-44.06 %; p = 0.005) in dual vs triple sulbactam based antibiotic combination therapy. The percentage difference in requirement of inotropes during therapy and HsCRP reduction after 7 days of therapy was 23.65 % (95 % CI 6.43 %-38.3 %; p = 0.007) and 25.1 % (95%CI 10.1 %-38.2 %; p < 0.001) respectively when compared between dual vs triple sulbactam based antibiotic combination therapy.
Treatment with sulbactam, polymyxin B and minocycline combination antibiotic therapy was associated with significantly lower 28-day mortality. Moreover, the lower requirement of inotropes during treatment and a significant reduction in HsCRP level favours this combination antibiotic therapy in VAP caused by CRAB.
耐碳青霉烯类鲍曼不动杆菌（CRAB）是呼吸机相关性肺炎（VAP）的常见病因。一些体外数据支持多种联合抗生素治疗。然而，对于CRAB所致VAP的治疗，还需要更多的体内研究。本回顾性研究旨在评估包括舒巴坦在内的多种联合抗生素治疗对CRAB所致VAP结局的有效性。
纳入诊断为CRAB所致VAP的成年患者（年龄≥18岁）。多微生物感染患者被排除在研究之外。观察接受基于舒巴坦的抗生素联合治疗的CRAB相关性VAP患者的结局。主要结局是CRAB所致VAP诊断后的28天死亡率。治疗期间血清高敏C反应蛋白（HsCRP）的降低和血管活性药物的使用需求为次要结局。比较各种基于舒巴坦的抗生素联合治疗之间的结局。
共纳入103例患者。44例（42.7%）患者接受舒巴坦与米诺环素或舒巴坦与多粘菌素B的双联抗生素联合治疗，59例（57.3%）患者接受舒巴坦、多粘菌素B和米诺环素的三联抗生素联合治疗。基于舒巴坦的双联与三联抗生素联合治疗的28天死亡率百分比差异为27.51%（95%CI 8.03%-44.06%；p = 0.005）。基于舒巴坦的双联与三联抗生素联合治疗相比，治疗期间血管活性药物使用需求的百分比差异为23.65%（95%CI 6.43%-38.3%；p = 0.007），治疗7天后HsCRP降低的百分比差异为25.1%（95%CI 10.1%-38.2%；p < 0.001）。
舒巴坦、多粘菌素B和米诺环素联合抗生素治疗与显著更低的28天死亡率相关。此外，治疗期间血管活性药物使用需求较低以及HsCRP水平显著降低有利于这种联合抗生素治疗CRAB所致的VAP。
