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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15.	吕根法, 卫国, 郭毅斌, 等. 多粘菌素 B 拮抗内毒素的体外作用研究. 第三军医大学学报, 2004, 26(14): 1252-1254.

1. 蔡兴东, 胡成平, 钟有清, 等. 院内下呼吸道非发酵菌感染的调查及多重耐药非发酵菌下呼吸道感染危险因素分析. 中国呼吸与危重监护杂志, 2009, 8(10): 28-32.
2. 王凌伟, 陈升汶. 不动杆菌微生物学耐药研究新进展. 国外医药抗生素分册, 2004, 25(3): 134-137.
3. 胡付品, 朱德妹, 汪复, 等. 2013 年中国 CHINET 细菌耐药性监测. 中国感染与化疗杂志, 2014, 14(5): 365-374.
4. 陈冠荣. 多粘菌素临床应用进展及应对超级细菌. 医药导报, 2011, 30(2): 135-140.
5. 陈佰义, 何礼贤, 胡必杰, 等. 中国鲍曼不动杆菌感染诊治与防控专家共识. 中华医学杂志, 2012, 92(2): 76-82.
6. 韩晓燕, 董爱英, 成杰. 鲍曼不动杆菌的耐药性分析. 中国综合临床, 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, 汪复,等. 2011 年中国 CHINET 细菌耐药性监测. 中国感染与化疗杂志, 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, 史录文, 王睿, 等. 粘菌素等抗菌药物对临床分离鲍曼不动杆菌的抗菌活性. 中国临床药理学与治疗学, 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. 吕根法, 卫国, 郭毅斌, 等. 多粘菌素 B 拮抗内毒素的体外作用研究. 第三军医大学学报, 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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