与黏菌素/美罗培南相比，黏菌素/利福平治疗耐碳青霉烯类引起的呼吸机相关性肺炎的有效性：一项随机对照临床试验
The Effectiveness of Colistin/Rifampin Compared to Colistin/Meropenem in the Treatment of Ventilator-associated Pneumonia Caused by Carbapenem-resistant : A Randomized Controlled Clinical Trial.
作者信息
Kazemi Najafabadi Malihe, Alikiaei Babak, Khorvash Farzin, Shafiee Fatemeh, Soltani Rasool
机构信息
Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran.
出版信息
J Res Pharm Pract. 2025 Mar 11;13(3):65-71. doi: 10.4103/jrpp.jrpp_51_24. eCollection 2024 Jul-Sep.
OBJECTIVE
Treating ventilator-associated pneumonia (VAP) caused by carbapenem-resistant (CRAB) is still a significant challenge. This study evaluated the effectiveness of the colistin/rifampin regimen compared to the usual colistin/meropenem regimen in treating patients with VAP caused by CRAB.
METHODS
In a randomized controlled clinical trial, the patients with CRAB-related VAP were randomly assigned to experimental ( = 21) and control ( = 24) groups. The first group received colistin 4.5 MIU IV infusion every 12 h and rifampin 300 mg PO every 12 h, and the second group received colistin with the same dose and meropenem 2 g IV every 8 h for 10 days. The clinical response (complete response, partial response, or treatment failure) and mortality rate at the end of the intervention were recorded and compared between the two groups.
FINDINGS
The complete response rate was higher ( = 8; 66.70%), and the failure rate was lower ( = 4; 26.70%) in the experimental group than in the control group ( = 4; 33.30%, and n = 11; 73.30%, respectively), but the differences were not statistically significant. The mortality rate was three patients in both experimental (14.28%) and control (12.50%) groups; however, the difference was not statistically significant ( = 0.860; odds ratio: 1.143, 95% confidence interval: 0.258-5.067).
CONCLUSION
The colistin/rifampin combination can be considered an alternative regimen to colistin/meropenem in the treatment of VAP caused by CRAB.
目的
治疗由耐碳青霉烯类鲍曼不动杆菌（CRAB）引起的呼吸机相关性肺炎（VAP）仍然是一项重大挑战。本研究评估了与常用的黏菌素/美罗培南方案相比，黏菌素/利福平方案治疗CRAB所致VAP患者的有效性。
方法
在一项随机对照临床试验中，将CRAB相关VAP患者随机分为试验组（n = 21）和对照组（n = 24）。第一组每12小时静脉输注黏菌素4.5 MIU，每12小时口服利福平300 mg，第二组接受相同剂量的黏菌素和每8小时静脉输注美罗培南2 g，共10天。记录两组干预结束时的临床反应（完全缓解、部分缓解或治疗失败）和死亡率并进行比较。
结果
试验组的完全缓解率更高（n = 8；66.70%），失败率更低（n = 4；26.70%），而对照组分别为n = 4；33.30%和n = 11；73.30%，但差异无统计学意义。试验组和对照组的死亡率均为3例患者（分别为14.28%和12.50%）；然而，差异无统计学意义（P = 0.860；比值比：1.143，95%置信区间：0.258 - 5.067）。
结论
在治疗CRAB所致VAP时，黏菌素/利福平联合方案可被视为黏菌素/美罗培南的替代方案。
Zotero 插件