碳青霉烯类抗生素延长输注联合舒巴坦对广泛耐药鲍曼不动杆菌呼吸机相关性肺炎的疗效

Efficacy of extended-infusion of carbapenem plus sulbactam for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter baumannii

目的评价碳青霉烯类抗生素延长输注联合舒巴坦对广泛耐药鲍曼不动杆菌（XDRAB）呼吸机相关性肺炎的疗效。方法回顾性分析2015年1月至2016年12月北京大学第一医院使用碳青霉烯类抗生素延长输注联合舒巴坦，或以替加环素为基础联合治疗的41例XDRAB呼吸机相关性肺炎患者的病例资料。其中21例使用碳青霉烯类抗生素延长输注联合舒巴坦治疗（碳青霉烯组），另20例使用替加环素联合其他抗菌药物治疗（替加环素组）。比较两组患者的一般情况、细菌清除率、二重感染率、新菌种定植率、3d临床缓解率、临床治愈率和治疗期间病死率。结果除碳青霉烯组患者年龄较轻以外，两组患者其余一般资料无显著性差异。两种治疗方案细菌清除率均为0％。碳青霉烯组出现1例（4．8％）二重感染，替加环素组未发生二重感染（P=1．000），两组新菌种定植发生率分别为14．3％和25．O％（P=0．638）。碳青霉烯组和替加环素组临床治愈率分别为57．1％和50．0％（P=0．647），3d临床缓解率分别为52．4％和45．0％（P=0．636），治疗期间病死率分别为9．5％和20．0％（P=0．612）。无严重药物不良反应发生。结论碳青霉烯类抗生素延长输注联合舒巴坦对XDRAB呼吸机相关性肺炎的疗效与以替加环素为基础的联合治疗相近。

Objective To evaluate the efficacy of extended-infusion of carbapenem plus sulbactam for ventilator-associated pneumonia caused by extensive drug-resistant Acinetobacter baumannii （XDRAB）. Methods Clinical data of patients with ventilator-associated pneumonia caused by XDRAB who were treated with extended-infusion carbapenem plus sulbactam or tigecycline-based therapy in Peking University First Hospital from January 2015 to December 2016 were collected and reviewed in this retrospective study. Twenty-one patients were treated with extended-infusion carbapenem plus sulbactam, and 20 other patients received tigecycline combined with other antibiotics. The general status of the patient, microbiological eradication rate, snperinfection rate, new microorganism colonization rate, clinical resolution rate on the third day, clinical cure rate and mortality during treatment were compared between the two groups. Results The two groups shared similar characteristics except that patients in the carbapenem group were younger. Microbiological eradication was not observed. Superinfeetions occurred in 1 patients （4. 8% ） in the carbapenem group and 0 patients in the tigecycline group （P = 1.000）, the occurrences of new microorganisms colonization were 14. 3% and 25.0% respectively （P = 0. 638 ）. Clinical cure were achieved in 57.1% of the patients in the carbapenem group and 50. 0% of the patients in the tigeeycline group （ P= 0. 647 ） , the clinical resolution rates on the third day were 52.4% and 45.0% respectively （ P = 0. 636 ）. The mortality during treatment was 9.5% in earbapenem group, and 20. 0% in tigecycline group （P = 0. 612 ）. No serious adverse drug reactions occurred. Conclusions Ventilator-associated pneumonia caused by XDRAB treated with either extended-infusion earbapenem plus sulbactam or tigecycline-based therapy has a similar clinical outcome.