The clinical effects of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant <i>Acinetobacter baumannii</i> in chronic obstructive pulmonary disease _Chinese Journal of Respiratory and Critical Care Medicine

Authors：

MIAO Weiwei , MA Liang , LI Bo ,  JIANG Lixue

Department of Respiratory Medicine, The First Hospital of Harbin, Harbin, Heilongjiang 150010, P.R.China;

Corresponding?author：

JIANG Lixue, Email: zyfpretty@163.com

Keywords：

Polymyxin B; Acinetobacter baumannii; Pandrug resistance; Chronic obstructive pulmonary disease; Ventilator-associated pneumonia

DOI：

10.7507/1671-6205.201610049

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Objective To evaluate the clinical effects and safety of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant Acinetobacter baumannii (PDR-AB) in patients with chronic obstructive pulmonary disease (COPD). Methods COPD patients who were diagnosed as ventilator-associated pneumonia caused by PDR-AB and treated with polymyxin B between January 2015 and August 2016 in this hospital were included in this retrospective study. The patients’ symptoms, vital signs, and the results of laboratory examinations were recorded before and after treatment. The clinical cure rates, microbiological eradication rates, mortality and safety were also measured. Results A total of 11 cases were included in this study. Mean time of therapy was 10 days, ranged 8-13 days. After treatment with polymyxin B, most of the patients’ clinical symptoms, signs, and results of laboratory tests as well as imaging examinations were significantly improved. Seven cases had clinical response, and the clinical efficacy rate was 63.6%; 8 cases achieved bacteriological eradication, with the bacteriological eradication rate of 72.7%. Four patients died, and the overall mortality was 36.4%. Only 1 case discontinued treatment with polymyxin B because of the drug fever. Conclusions Polymyxin B might be an alternative option for COPD patients with ventilator-associated pneumonia caused by PDR-AB, who is non-responder to prior antimicrobial therapy. However, this method should be evaluated cautiously in prospective well-controlled studies.

Citation： MIAO Weiwei, MA Liang, LI Bo, JIANG Lixue. The clinical effects of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant Acinetobacter baumannii in chronic obstructive pulmonary disease . Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 332-336. doi: 10.7507/1671-6205.201610049 Copy

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1. 蔡興東, 胡成平, 鐘有清, 等. 院內下呼吸道非發酵菌感染的調查及多重耐藥非發酵菌下呼吸道感染危險因素分析. 中國呼吸與危重監護雜志, 2009, 8(10): 28-32.
2. 王凌偉, 陳升汶. 不動桿菌微生物學耐藥研究新進展. 國外醫藥抗生素分冊, 2004, 25(3): 134-137.
3. 胡付品, 朱德妹, 汪復, 等. 2013 年中國 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2014, 14(5): 365-374.
4. 陳冠榮. 多粘菌素臨床應用進展及應對超級細菌. 醫藥導報, 2011, 30(2): 135-140.
5. 陳佰義, 何禮賢, 胡必杰, 等. 中國鮑曼不動桿菌感染診治與防控專家共識. 中華醫學雜志, 2012, 92(2): 76-82.
6. 韓曉燕, 董愛英, 成杰. 鮑曼不動桿菌的耐藥性分析. 中國綜合臨床, 2013, 29(12): 1256-1257.
7. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis, 2016, 63(5): e61-e111.
8. Jabes D. The antibiotic R&D pipeline: an update. Curr Opin Microbiol, 2011, 14(5): 564-569.
9. Donadio S, Maffioli S, Monciardini P, et al. Antibiotic discovery in the twenty-first century: current trends and future perspectives. J Antibiotics, 2010, 63(8): 423-430.
10. 胡付品, 朱德姝, 汪復,等. 2011 年中國 CHINET 細菌耐藥性監測. 中國感染與化療雜志, 2012, 12(5): 321-329.
11. Yuan Z, Tam VH. Polymyxin B: a new strategy for multidrug-resistant Gram-negative organism. Expert Opin Investig Drugs, 2008,17(5): 661-668.
12. 李然, 史錄文, 王睿, 等. 粘菌素等抗菌藥物對臨床分離鮑曼不動桿菌的抗菌活性. 中國臨床藥理學與治療學, 2009, 14(3): 287-291.
13. Kee S, Cheon GH, Par KJ, et al. Use of colistin against multidrug resistant pseudomonas and acinetobacter species [C/CD]. 47^th inter science conference on antimicrobial agent and chemotherapy [M]. Chicago: American Society for Microbiology, 2006, 587.
14. Hermsen ED, Sullivan CJ, Rotschafer JC. Polymyxins: pharmacology, pharmacokinetics, pharmacodynamics, and clinical applications. Infect Dis Clin North Am, 2003, 17(3): 545-562.
15. 呂根法, 衛國, 郭毅斌, 等. 多粘菌素 B 拮抗內毒素的體外作用研究. 第三軍醫大學學報, 2004, 26(14): 1252-1254.

Chinese Journal of Respiratory and Critical Care Medicine

The clinical effects of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant Acinetobacter baumannii in chronic obstructive pulmonary disease

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