Zhang Ye, Wang Fei, Wang Min, Xu Wenhui, Wang Aiping, Ding Yueping
Department of Pharmacy, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Department of Intensive Care Unit, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People's Republic of China.
Infect Drug Resist. 2025 Sep 4;18:4699-4710. doi: 10.2147/IDR.S541192. eCollection 2025.
To investigate the clinical efficacy and safety of intravenous omadacycline compared to intravenous tigecycline in patients with severe pneumonia caused by carbapenem-resistant gram-negative bacilli (CRGNB), and to explore the factors influencing 28-day all-cause mortality.
Our retrospective analysis was conducted on adult patients with CRGNB-associated severe pneumonia who received intravenous omadacycline or tigecycline for at least 72 hours in the intensive care unit (ICU) between April 1, 2023, and March 31, 2025. The primary outcome was 28-day all-cause mortality, while secondary endpoints included clinical efficacy and microbiological clearance rates. Safety was also assessed. Logistic regression analysis was used to identify factors associated with 28-day all-cause mortality.
A total of 80 patients with CRGNB-associated severe pneumonia were enrolled, including 43 in the omadacycline group and 37 in the tigecycline group. Compared with the tigecycline group, there was no statistically significant difference in 28-day mortality (χ = 2.882, p = 0.090) or microbiological clearance rate (58.14% vs 48.65%, p = 0.501) in the omadacycline group. However, the omadacycline group showed a significantly higher clinical efficacy rate (72.09% vs 43.24%, p = 0.012) and a markedly lower incidence of adverse events (4.65% vs 24.32%, p = 0.020). Multivariate logistic regression analysis revealed that combination therapy with β-lactams was an independent predictor of reduced 28-day mortality, whereas central venous catheterization and baseline C-reactive protein (CRP) levels were independently associated with increased 28-day mortality.
Our study found that omadacycline is comparable to tigecycline in clinical effectiveness for the treatment of CRGNB-associated severe pneumonia, while exhibiting a better safety profile. Novel tetracyclines may be used in combination with β-lactams for the treatment of severe pneumonia caused by CRGNB.
探讨静脉注射奥马环素与静脉注射替加环素治疗耐碳青霉烯类革兰阴性杆菌（CRGNB）所致重症肺炎的临床疗效和安全性，并探讨影响28天全因死亡率的因素。
对2023年4月1日至2025年3月31日期间在重症监护病房（ICU）接受静脉注射奥马环素或替加环素治疗至少72小时的CRGNB相关重症肺炎成年患者进行回顾性分析。主要结局为28天全因死亡率，次要终点包括临床疗效和微生物清除率。同时评估安全性。采用逻辑回归分析确定与28天全因死亡率相关的因素。
共纳入80例CRGNB相关重症肺炎患者，其中奥马环素组43例，替加环素组37例。与替加环素组相比，奥马环素组28天死亡率（χ = 2.882，p = 0.090）或微生物清除率（58.14%对48.65%，p = 0.501）无统计学显著差异。然而，奥马环素组的临床有效率显著更高（72.09%对43.24%，p = 0.012），不良事件发生率显著更低（4.65%对24.32%，p = 0.020）。多因素逻辑回归分析显示，β-内酰胺类联合治疗是降低28天死亡率的独立预测因素，而中心静脉置管和基线C反应蛋白（CRP）水平与28天死亡率增加独立相关。
我们的研究发现，奥马环素在治疗CRGNB相关重症肺炎的临床有效性方面与替加环素相当，同时具有更好的安全性。新型四环素类药物可与β-内酰胺类联合用于治疗CRGNB所致重症肺炎。
