https://scholars.lib.ntu.edu.tw/handle/123456789/479708
標題: | Treatment outcomes of patients with non-bacteremic pneumonia caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii complex isolates: Is there any benefit of adding tigecycline to aerosolized colistimethate sodium? | 作者: | Jean S.-S. Hsieh T.-C. Lee W.-S. PO-REN HSUEH Hsu C.-W. Lam C. |
公開日期: | 2018 | 卷: | 97 | 期: | 39 | 起(迄)頁: | e12278 | 來源出版物: | Medicine (United States) | 摘要: | Few therapeutic options exist for various infections caused by extensively drug-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (XDR-Acb) complex isolates, including pneumonia. This study investigated the clinical efficacy between aerosolized colistimethate sodium (AS-CMS, 2 million units thrice a day) treatment alone or in combination with standard-dose tigecycline (TGC) in patients with non-bacteremic pneumonia due to XDR-Acb, and explored the factors influencing patients' 30-day mortality. A 1:1 case (n=106; receiving TGC plus AS-CMS) control (receiving AS-CMS alone with matching scores) observational study was conducted among adult patients with non-bacteremic XDR-Acb complex pneumonia in a Taiwanese medical center from January 2014 through December 2016. The clinically relevant data were retrospectively recorded. The primary endpoint was 30-day case fatality. Secondary endpoints investigated that if the co-morbidities, XDR-A. baumannii as a pneumonic pathogen, therapy-related factors, or airway colonization with colistin-resistant Acb negatively influenced the 14-day clinical condition of enrolled patients. A higher 30-day mortality rate was noted among the group receiving combination therapy (34.0% vs 22.6%; P=.17). The ?7-day AS-CMS therapy successfully eradicated > 90% of airway XDR-Acb isolates. Nevertheless, follow-up sputum specimens from 10 (6.4% [10/156]) patients were colonized with colistin-resistant Acb isolates. After the conditional factors were adjusted by multivariate logistic analysis, the only factor independently predicting the 30-day case-fatality was the failure of treating XDR-Acb pneumonia at 14 days (adjusted odds ratio [aOR]=38.2; 95% confidence interval [CI]=9.96-142.29; P<.001). Cox proportional regression analysis found that chronic obstructive pulmonary disease (COPD) (adjusted hazard ratio [aHR]=2.08; 95% CI=1.05-4.10; P=.035), chronic renal failure (aHR=3.00; 95% CI=1.52-5.90; P=.002), non-invasive ventilation use (aHR=2.68; 95% CI=1.37- 5.25; P=.004), and lack of TGC therapy (aHR=0.52; 95% CI=0.27-1.00; P=.049) adversely influenced the 14-day clinical outcomes. Conversely, the emergence of colistin-resistant Acb isolates in the follow-up sputum samples was not statistically significantly associated with curing or improving XDR-Acb pneumonia. In conclusion, aggressive pulmonary hygiene care, the addition of TGC, and corticosteroid dose tapering were beneficial in improving the 14-day patients' outcomes. ? 2018 the Author(s). |
URI: | https://scholars.lib.ntu.edu.tw/handle/123456789/479708 | ISSN: | 0025-7974 | DOI: | 10.1097/MD.0000000000012278 | SDG/關鍵字: | amikacin; carbapenem; ciprofloxacin; colistimethate; colistin; gentamicin; isepamicin; piperacillin plus tazobactam; tigecycline; antiinfective agent; colistin; colistinmethanesulfonic acid; minocycline; tigecycline; adult; aged; antibiotic resistance; antibiotic therapy; Article; case control study; case fatality rate; chronic kidney failure; chronic obstructive lung disease; comorbidity; controlled study; female; follow up; human; major clinical study; male; mortality; mortality rate; multidrug resistant Acinetobacter baumannii; noninvasive ventilation; observational study; pneumonia; priority journal; regression analysis; retrospective study; steroid therapy; Taiwanese; treatment failure; treatment outcome; Acinetobacter; Acinetobacter infection; analogs and derivatives; combination drug therapy; drug effect; isolation and purification; microbiology; middle aged; multidrug resistance; pneumonia; survival rate; Taiwan; very elderly; Acinetobacter; Acinetobacter Infections; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Case-Control Studies; Colistin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Male; Middle Aged; Minocycline; Pneumonia; Retrospective Studies; Survival Rate; Taiwan; Treatment Outcome |
顯示於: | 醫學院附設醫院 (臺大醫院) |
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