Abstract：
OBJECTIVE: Sulbactam (SBT) is one of the most significant treatments for patients with extensively drug-resistant Acinetobacter baumannii (XDR-AB). However, the efficacy and safety of SBT and its high dose regimen has not been well documented. This retrospective study aimed to assess the efficacy and safety of SBT-based treatment, particularly at high-dose (≥ 6 g/day), for XDR-AB infection.
METHODS: A total of 52 XDR-AB infected patients treated with intravenous SBT at Peking Union Medical College Hospital were included. The primary outcome was 28-day all-cause mortality, while the secondary outcome was 14-day clinical response and the time of response. The formulation of SBT in our study is 0.5 g per vial.
RESULTS: Among the patients, the 28-day all-cause mortality rate was 36.5% (19/52), and the favorable 14-day clinical response rate was 59.6% (31/52). The 28-day mortality was independently associated coinfection with gram-positive bacteria (GPB) and a shorter duration of therapy. Patients with intracranial infection might have a longer survival time. A favorable 14-day clinical response was associated with the dose of SBT, and a longer treatment duration. However, the higher creatinine clearance (CrCl) associated with a worse clincal response. In addition, a higher SBT dosage was significantly correlated with a shorter time to clinical response. No adverse effects related were reported.
CONCLUSIONS: The single-agent formulation of SBT emerges as a promising alternative for the treatment of XDR-AB infection, such as intracranial infection, particularly at high doses (≥ 6 g/day). Besides, longer duration of treatment correlates with higher survival rate and better favorable clinical response. Higher CrCl negatively correlates with favorable clinical response.
METHODS: A total of 52 XDR-AB infected patients treated with intravenous SBT at Peking Union Medical College Hospital were included. The primary outcome was 28-day all-cause mortality, while the secondary outcome was 14-day clinical response and the time of response. The formulation of SBT in our study is 0.5 g per vial.
RESULTS: Among the patients, the 28-day all-cause mortality rate was 36.5% (19/52), and the favorable 14-day clinical response rate was 59.6% (31/52). The 28-day mortality was independently associated coinfection with gram-positive bacteria (GPB) and a shorter duration of therapy. Patients with intracranial infection might have a longer survival time. A favorable 14-day clinical response was associated with the dose of SBT, and a longer treatment duration. However, the higher creatinine clearance (CrCl) associated with a worse clincal response. In addition, a higher SBT dosage was significantly correlated with a shorter time to clinical response. No adverse effects related were reported.
CONCLUSIONS: The single-agent formulation of SBT emerges as a promising alternative for the treatment of XDR-AB infection, such as intracranial infection, particularly at high doses (≥ 6 g/day). Besides, longer duration of treatment correlates with higher survival rate and better favorable clinical response. Higher CrCl negatively correlates with favorable clinical response.
摘要：
目的：舒巴坦（SBT）是广泛耐药鲍曼不动杆菌（XDR-AB）患者最重要的治疗方法之一。然而,SBT及其高剂量方案的有效性和安全性尚未得到充分证明.这项回顾性研究旨在评估基于SBT的治疗的有效性和安全性。特别是在高剂量（≥6克/天），XDR-AB感染。
方法：纳入北京协和医院接受静脉SBT治疗的52例XDR-AB感染患者。主要结果是28天全因死亡率，而次要结局是14天临床缓解和缓解时间.在我们的研究中,SBT的配方为每瓶0.5g。
结果：在患者中，28天全因死亡率为36.5%(19/52),良好的14天临床缓解率为59.6%(31/52)。28天死亡率与革兰氏阳性菌（GPB）合并感染和较短的治疗持续时间独立相关。颅内感染患者的生存时间可能更长。良好的14天临床反应与SBT剂量相关，和更长的治疗时间。然而,较高的肌酐清除率（CrCl）与较差的临床反应相关。此外,较高的SBT剂量与较短的临床缓解时间显著相关.无相关不良反应报告。
结论：SBT的单药制剂成为治疗XDR-AB感染的有希望的替代药物，例如颅内感染，特别是在高剂量（≥6克/天）。此外,更长的治疗时间与更高的生存率和更好的临床反应相关。较高的CrCl与良好的临床反应负相关。
方法：纳入北京协和医院接受静脉SBT治疗的52例XDR-AB感染患者。主要结果是28天全因死亡率，而次要结局是14天临床缓解和缓解时间.在我们的研究中,SBT的配方为每瓶0.5g。
结果：在患者中，28天全因死亡率为36.5%(19/52),良好的14天临床缓解率为59.6%(31/52)。28天死亡率与革兰氏阳性菌（GPB）合并感染和较短的治疗持续时间独立相关。颅内感染患者的生存时间可能更长。良好的14天临床反应与SBT剂量相关，和更长的治疗时间。然而,较高的肌酐清除率（CrCl）与较差的临床反应相关。此外,较高的SBT剂量与较短的临床缓解时间显著相关.无相关不良反应报告。
结论：SBT的单药制剂成为治疗XDR-AB感染的有希望的替代药物，例如颅内感染，特别是在高剂量（≥6克/天）。此外,更长的治疗时间与更高的生存率和更好的临床反应相关。较高的CrCl与良好的临床反应负相关。
