Optimizing Treatment Strategies for Carbapenem-Resistant Acinetobacter Baumannii-Associated Pneumonia: A Multicenter Study in Chinese Hospitals.

IF 2.9 3区医学 Q2 INFECTIOUS DISEASES Infection and Drug Resistance Pub Date : 2024-10-13 eCollection Date: 2024-01-01 DOI:10.2147/IDR.S473088

Xiaotong Tian, Jing Lin, Menglan Zhou, Ying Ge, Taisheng Li, Li Zhang, Zhengyin Liu

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Abstract

Purpose: To evaluate the clinical outcomes and safety of tigecycline (TGC) plus cefoperazone/sulbactam (CPS) or TGC monotherapy in patients with hospital-acquired pneumonia (HAP) caused by Carbapenem-Resistant Acinetobacter baumannii (CRAB).

Methods: This was a retrospective analysis of multicenter data from 62 Chinese hospitals with CRAB HAP. Risk factors for receiving TGC with CPS therapy and predictors of mortality were assessed using multivariate logistic and Cox regression analyses, respectively. Propensity score matching (PSM) evaluated the efficacy and safety of antimicrobial regimens.

Results: A total of the 180 patients were included, with 95 receiving TGC monotherapy and 85 receiving combination therapy. Multivariate logistic regression analysis revealed that older age (P = 0.011), and intensive care unit (ICU) admission (P = 0.007) were significant risk factors for combination therapy. Multivariate Cox regression demonstrated that combination therapy was associated with a significantly higher risk of 90-day mortality (P = 0.031). Patients in the standard-dose TGC (SDT) plus CPS subgroup had significantly higher rates of SOFA scores ≥ 7 (P = 0.009) and MV used (P = 0.028), as well as higher 30-/90-day mortality compared to high-dose TGC (HDT) plus CPS group. TGC plus CPS significantly reduced CRP levels (P = 0.009), while the variations in ALT, TBIL, Cr, Hb, and PLT levels did not differ between different antimicrobial regimens after PSM.

Conclusion: HDT and CPS combination therapy was more effective in patients with advanced age and more severe condition. Safety profiles of different antimicrobial regimens were similar with liver, kidneys, and coagulation functions.

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优化耐碳青霉烯类鲍曼不动杆菌相关肺炎的治疗策略：中国医院多中心研究。

目的：评估替加环素（TGC）联合头孢哌酮/舒巴坦（CPS）或TGC单药治疗由耐碳青霉烯类鲍曼不动杆菌（CRAB）引起的医院获得性肺炎（HAP）患者的临床疗效和安全性：这是一项对中国 62 家医院 CRAB HAP 患者多中心数据的回顾性分析。采用多变量逻辑分析和 Cox 回归分析分别评估了接受 TGC 与 CPS 治疗的风险因素和死亡率预测因素。倾向评分匹配（PSM）评估了抗菌方案的有效性和安全性：共纳入 180 例患者，其中 95 例接受 TGC 单一疗法，85 例接受联合疗法。多变量逻辑回归分析显示，年龄较大（P = 0.011）和入住重症监护室（ICU）（P = 0.007）是联合疗法的重要风险因素。多变量 Cox 回归显示，联合疗法与 90 天死亡风险显著升高有关（P = 0.031）。与大剂量 TGC (HDT) 加 CPS 亚组相比，标准剂量 TGC (SDT) 加 CPS 亚组患者的 SOFA 评分≥7（P = 0.009）和 MV 使用率（P = 0.028）明显更高，30/90 天死亡率也更高。TGC加CPS可明显降低CRP水平（P = 0.009），而PSM后不同抗菌方案的ALT、TBIL、Cr、Hb和PLT水平变化无差异：结论：HDT 和 CPS 联合疗法对高龄和病情较重的患者更有效。不同抗菌方案对肝脏、肾脏和凝血功能的安全性相似。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection and Drug Resistance Medicine-Pharmacology (medical)

CiteScore

5.60

自引率

7.70%

发文量

826

审稿时长

16 weeks

期刊介绍： About Journal Editors Peer Reviewers Articles Article Publishing Charges Aims and Scope Call For Papers ISSN: 1178-6973 Editor-in-Chief: Professor Suresh Antony An international, peer-reviewed, open access journal that focuses on the optimal treatment of infection (bacterial, fungal and viral) and the development and institution of preventative strategies to minimize the development and spread of resistance.