背景:由于选择耐碳青霉烯类革兰氏阴性菌(CR-GNB)的硫酸粘菌素和硫酸多粘菌素B(PBS)的困难,我们比较了这两种老多粘菌素治疗CR-GNB感染危重患者的疗效和安全性.
方法:对ICU感染CR-GNB的104例患者采用PBS(68例)或硫酸粘菌素(36例)进行回顾性分组。临床疗效,包括症状,炎症参数,退热,分析预后和微生物疗效。肝毒性,肾毒性,通过TBiL评估血液毒性,ALT,AST,肌酐,和血小板。
结果:硫酸粘菌素和PBS之间的人口统计学特征没有显着差异。大多数CR-GNB在呼吸道培养(91.7%vs86.8%),几乎所有人都对多粘菌素敏感(98.2%vs100%,MIC≤2μg/ml)。硫酸粘菌素(57.1%)的微生物效力显著高于PBS(30.8%)(p=0.022),然而,两组的临床成功率没有显着差异(33.8%vs41.7%),以及死亡率,退热,影像学缓解,在医院的日子,微生物再感染,和预后,几乎所有患者在7天内退热(95.6%vs89.5%)。
结论:两种多粘菌素均可用于CR-GNB感染的危重患者,硫酸粘菌素在微生物清除方面优于PBS。这些结果强调了鉴定可能受益于多粘菌素且具有较高死亡风险的CR-GNB患者的必要性。
BACKGROUND: With the difficulties in choosing colistin sulfate and polymyxin B sulfate (PBS) for carbapenem-resistant gram-negative bacteria (CR-GNB), we compared the efficacy and safety of these two old
polymyxins in treatment of critically ill patients infected with CR-GNB infection.
METHODS: One hundred four patients infected with CR-GNB in ICU were retrospectively grouped by PBS (68 patients) or colistin sulfate (36 patients). Clinical efficacy including symptoms, inflammatory parameters, defervescence, prognosis and microbial efficacy were analyzed. Hepatotoxicity, nephrotoxicity, and hematotoxicity were evaluated by TBiL, ALT, AST, creatinine, and thrombocytes.
RESULTS: Demographic characteristics between colistin sulfate and PBS were not significantly different. Most of the CR-GNB were cultured in respiratory tract (91.7% vs 86.8%), and almost all were polymyxin-sensitive (98.2% vs 100%, MIC ≤ 2 μg/ml). The microbial efficacy in colistin sulfate (57.1%) was significantly higher than PBS (30.8%) (p = 0.022), however, no significant difference in clinical success was seen in both groups (33.8% vs 41.7%), as well as mortality, defervescence, imaging remission, days in the hospital, microbial reinfections, and prognosis, and almost all patients defervesce within 7 days (95.6% vs 89.5%).
CONCLUSIONS: Both
polymyxins can be administrated in critically ill patients infected with CR-GNB and colistin sulfate is superior to PBS in microbial clearance. These results highlight the necessity of identifying CR-GNB patients who may benefit from polymyxin and who are at higher risk of mortality.