Abstract：
Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is common worldwide. Despite carbapenem resistance, standard-dose carbapenems are still used in clinical practice. Hence in this study, we aimed to compare the efficacy and outcomes of a regimen containing standard-dose carbapenems with those of a regimen lacking carbapenems during the treatment of critically ill patients with CRAB nosocomial pneumonia in the intensive care unit (ICU). Initially, 735 patients were recruited for this multicentre retrospective cohort study. After exclusion, time-window bias adjustment, and propensity score matching, multiple clinical outcomes were compared between the carbapenem-containing (CC) (n = 166) and no carbapenem-containing (NCC) (n = 166) groups. The CC group showed a higher risk of clinical failure on day 7 than the NCC group (44.6% vs. 33.1%, P = 0.043). The lengths of ICU stay (21 and 16 days, P = 0.024) and hospital stay (61 and 44 days, P = 0.003) were longer in the CC group than in the NCC group. Multivariate analysis showed that the CC regimen was associated with higher clinical failure (adjusted odds ratio (aOR) = 1.64, 95% CI = 1.05-2.56, P = 0.031) and lower microbiological eradication (aOR = 0.48, 95% CI = 0.23-1.00, P = 0.049) at day 7 than the NCC group. Thus, a regimen containing a standard dose of carbapenem should be prescribed with caution for treating CRAB nosocomial pneumonia in the ICU.
摘要：
耐碳青霉烯类鲍曼不动杆菌(CRAB)感染在全球范围内普遍存在。尽管碳青霉烯耐药,标准剂量碳青霉烯类抗生素仍在临床实践中使用。因此，在这项研究中，我们的目的是比较在重症监护病房(ICU)治疗CRAB医院性肺炎危重患者期间,含有标准剂量碳青霉烯类抗生素的方案与不含有碳青霉烯类抗生素的方案的疗效和结局.最初，这项多中心回顾性队列研究招募了735名患者。排除后,时间窗口偏差调整，和倾向得分匹配，在含碳青霉烯(CC)组(n=166)和不含碳青霉烯(NCC)组(n=166)之间比较了多种临床结局.CC组在第7天的临床失败风险高于NCC组(44.6%vs.33.1%,P=0.043)。ICU住院时间(21天和16天，P=0.024）和住院时间（61天和44天，P=0.003）在CC组中比在NCC组中更长。多因素分析显示，与NCC组相比，CC方案在第7天具有较高的临床失败率（校正比值比（aOR）=1.64，95％CI=1.05-2.56，P=0.031）和较低的微生物根除率（aOR=0.48，95％CI=0.23-1.00，P=0.049）。因此，在ICU治疗CRAB医院获得性肺炎时,应谨慎使用含有标准剂量碳青霉烯的方案.
