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首页> 外文期刊>International journal of antimicrobial agents >Clinical epidemiology, treatment and prognostic factors of extensively drug-resistant Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients
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Clinical epidemiology, treatment and prognostic factors of extensively drug-resistant Acinetobacter baumannii ventilator-associated pneumonia in critically ill patients

机译：重症患者广泛耐药的鲍曼不动杆菌呼吸机相关性肺炎的临床流行病学，治疗和预后因素

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Limited data exist regarding prognostic factors and optimal antimicrobial treatment of infections caused by extensively drug-resistant Acinetobacter baumannii (XDR-AB). This retrospective cohort study included 93 adult patients who developed ventilator-associated pneumonia (VAP) due to XDR-AB in the ICU of the University Hospital of Heraklion, Greece, from October 2012 to April 2015. XDR-AB isolates were mainly susceptible to colistin (93.5%) and tigecycline (25.8%), whereas 6 (6.5%) were pandrugresistant. Prior to infection, patients had long durations of mechanical ventilation and hospital stay and multiple exposures to antibiotics. Median Charlson co-morbidity and APACHE II scores were 2 and 17, respectively. Mortality at 28 days of infection onset was high (34.4%) despite high rates of in-vitroactive empirical (81.7%) and definitive (90.3%) treatment. Active colistin-based combination therapy (n = 55) and monotherapy (n = 29) groups had similar 28-day mortality (27.6% vs. 30.9%, respectively) and Kaplan-Meier survival estimates over time. In multivariable Cox regression, advanced age (aHR = 1.05 per year increase, 95% CI 1.02-1.09), rapidly fatal underlying disease (aHR = 2.64, 95% CI 0.98-9.17) and APACHE II score (aHR = 1.06 per unit increase, 95% CI 0.99-1.14) were identified as independent predictors of 28day mortality, but no difference in mortality hazards between the active colistin-based combination therapy and monotherapy groups was produced (aHR = 0.88, 95% CI 0.35-2.38). These results support the use of colistin as a first-line agent against VAP in settings where XDR-AB is endemic, but oppose the introduction of colistin-based combination therapy as standard treatment. (C) 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
机译：关于由广泛耐药的鲍曼不动杆菌（XDR-AB）引起的感染的预后因素和最佳抗菌治疗的数据有限。这项回顾性队列研究包括2012年10月至2015年4月在希腊伊拉克利翁大学医院的ICU内因XDR-AB患上呼吸机相关性肺炎（VAP）的93名成年患者。XDR-AB分离株主要对大肠杆菌素敏感（93.5％）和替加环素（25.8％），而6（6.5％）则是耐pandrug的。感染前，患者需要长时间的机械通气和住院时间，并多次接触抗生素。 Charlson合并症的中位数和APACHE II评分分别为2和17。尽管体外经验治疗（81.7％）和确定性治疗（90.3％）的发生率很高，但感染后28天的死亡率仍很高（34.4％）。基于主动大肠菌素的联合疗法（n = 55）和单一疗法（n = 29）组的28天死亡率（分别为27.6％和30.9％）相似，并且随时间推移的Kaplan-Meier存活率估算值较高。在多变量Cox回归中，高龄（aHR = 1.05每年增加，95％CI 1.02-1.09），快速致命性基础疾病（aHR = 2.64，95％CI 0.98-9.17）和APACHE II评分（aHR = 1.06每单位增加，95％CI 0.99-1.14）被确定为28天死亡率的独立预测因子，但基于活性大肠菌素的联合治疗组和单药治疗组之间的死亡危险没有差异（aHR = 0.88，95％CI 0.35-2.38）。这些结果支持在XDR-AB流行的环境中将粘菌素用作抗VAP的一线药物，但反对引入基于粘菌素的联合疗法作为标准治疗。 （C）2016 Elsevier B.V.和国际化学疗法学会。版权所有。

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