You Li, Ding Ru-Meng, Liu Ting-Ting, Meng Hai-Yang, Li Duo-Lu
Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China.
J Glob Antimicrob Resist. 2025 Jun 3;44:81-88. doi: 10.1016/j.jgar.2025.05.002.
Intracranial infections caused by Acinetobacter baumannii (A. baumannii) are common and life-threatening. This study aimed to compare the clinical efficacy and risk factors associated with 30-d mortality rates between intravenous (IV) polymyxin B and a combination of intravenous (IV) with intrathecal (IVT)/intracerebral (ITH) polymyxin B in the treatment of this type of intracranial infection.
This retrospective study analysed patients with A. baumannii intracranial infections treated from November 2018 to March 2023. Based on the established inclusion and exclusion criteria, 57 patients were included in the study. Patients treated with IV polymyxin B combined with IVT/ITH polymyxin B were assigned to the IV plus IVT/ITH group, while those treated solely with IV polymyxin B were assigned to the IV group. Baseline characteristics and treatment outcomes were systematically collected and analysed. Kaplan-Meier survival analysis and multivariate logistic regression analysis were performed.
The study involved 57 patients who acquired A. baumannii intracranial infection. The cure rate was 31.6% (18/57) and a 30-d mortality rate of 33.3% (19/57). Compared to the IV group, the IV plus IVT/ITH group demonstrated a higher cure rate (15.4% vs. 45.2%, P = 0.034) and lower 30-d mortality (50.0% vs. 19.4%, P = 0.015). Multivariate logistic regression analysis indicated that the absence of IVT/ITH polymyxin B (P = 0.043) and the preexisting renal insufficiency at admission (P = 0.027) were independently associated with increased 30-d mortality.
The combination of IV and IVT/ITH polymyxin B administration represents an effective therapeutic strategy for A. baumannii infections, demonstrating higher cure rates, significantly reduced 30-d mortality, and a substantial survival advantage. Notably, ITH/IVT treatment does not appear to increase the incidence of neurotoxicity. However, the true incidence of neurotoxicity associated with IVT/ITH polymyxin B may be underestimated.
鲍曼不动杆菌引起的颅内感染常见且危及生命。本研究旨在比较静脉注射多粘菌素B与静脉联合鞘内/脑内注射多粘菌素B治疗此类颅内感染的临床疗效及与30天死亡率相关的危险因素。
这项回顾性研究分析了2018年11月至2023年3月期间接受治疗的鲍曼不动杆菌颅内感染患者。根据既定的纳入和排除标准，57例患者纳入研究。接受静脉注射多粘菌素B联合鞘内/脑内注射多粘菌素B治疗的患者被分配到静脉加鞘内/脑内注射组，而仅接受静脉注射多粘菌素B治疗的患者被分配到静脉注射组。系统收集并分析基线特征和治疗结果。进行了Kaplan-Meier生存分析和多因素逻辑回归分析。
该研究纳入了57例发生鲍曼不动杆菌颅内感染的患者。治愈率为31.6%（18/57），30天死亡率为33.3%（19/57）。与静脉注射组相比，静脉加鞘内/脑内注射组显示出更高的治愈率（15.4%对45.2%，P = 0.034）和更低的30天死亡率（50.0%对19.4%，P = 0.015）。多因素逻辑回归分析表明，未进行鞘内/脑内注射多粘菌素B（P = 0.043）和入院时存在肾功能不全（P = 0.027）与30天死亡率增加独立相关。
静脉联合鞘内/脑内注射多粘菌素B是治疗鲍曼不动杆菌感染的有效治疗策略，治愈率更高，30天死亡率显著降低，具有显著的生存优势。值得注意的是，脑内/鞘内注射治疗似乎并未增加神经毒性的发生率。然而，与鞘内/脑内注射多粘菌素B相关的神经毒性的真实发生率可能被低估。
