Carbapenem내성 Acinetobacter baumannii로 인한 인공호흡기연관 폐렴 환아에서 고용량 Ampicillin-Sulbactam과 Colistin 항균제 병합요법의 치료적 예후: 예비 연구
Outcome of High Dose Ampicillin-Sulbactam and Colistin Combination Therapy for Treating Ventilator-Associated Pneumonia Caused by Carbapenem-Resistant Acinetobacter baumannii: a Pilot Study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: Carbapenem-resistant Acinetobacter baumannii (CRAB)에 의한 인공호흡기연관 폐렴(ventilator-associated pneumonia, VAP)의 치료에 있어 고용량 ampicillin-sulbactam과 colistin의 병합요법 치료효과를 살펴보기 위한 예비 연구이다. 방법: 2017년도 6월부터 2018년도 8월까지 17명의 CRAB VAP 환자를 후향적으로 분석하였다. 10명(58.8%)의 환자는 고용량 ampicillin-sulbactam과 colistin 병합요법(병합치료군)으로 치료받았으며, 나머지 7명은 colistin 단독치료를 하였거나 colistin을 포함 또는 미포함하는 다양한 항균제의 병합치료(기타치료군)를 하였다. 본 연구는 두 그룹간의 임상 및 세균학적 결과를 비교하였다. 결과: 병합치료군에서 항균제 사용 후 발열기간은 1.30±1.70일이었고, 기타치료군에서는 1.71±1.49일이었다. 기관내관 흡인물 검체에서 균이 음전 될 때까지의 평균 기간은 병합치료군에서 3.40±1.71일 기타치료군에서 11.80±8.86일이었다(P=0.030). 항균제 치료 30일 이내 사망률은 병합치료균에서 1/10 (10%)이고 기타치료군에서 3/7 (42.9%)이었다. 결론: 소아의 CRAB에 의한 인공호흡기연관 폐렴 환자에서 고용량 ampicillin-sulbactam과 colistin의 병합요법이 임상적 예후를 개선시킬 수 있을 것으로 기대된다.
Abstract
Purpose: This pilot study aimed to evaluate the efficacy of high dose ampicillin-sulbactam and colistin combination therapy for ventilator-associated pneumonia (VAP) caused by carbapenem-resistant Acinetobacter baumannii (CRAB) in the pediatric intensive care unit of Pusan National University Children's Hospital. Methods: We retrospectively reviewed 17 pediatric patients with VAP caused by CRAB from June 2017 to August 2018. Ten (58.8%) patients were treated with high dose ampicillin-sulbactam and colistin combination therapy (combination therapy group), whereas 7 were treated with colistin only or with various combinations with or without colistin (other antibiotics group). Clinical and bacteriological outcomes were compared between the groups. Results: The mean duration of fever after antibiotic use was 1.30±1.70 days in the combination therapy group and 1.71±1.49 days in the other antibiotics group. The mean duration of days for negative conversion of endotracheal aspirate bacterial culture after antibiotic therapy was 3.40±1.71 days in the combination therapy group and 11.80±8.86 days in the other antibiotics group. The mortality rate within 30 days of antibiotic therapy was 1/10 (10%) in the combination therapy group and 3/7 (42.9%) in the other antibiotics group. Conclusions: High dose ampicillin-sulbactam and colistin combination therapy as early antibiotic treatment in VAP caused by CRAB in children could improve clinical outcomes.
참고문헌 (16)
- Pogue JM, "Carbapenem-resistance in gram-negative bacilli and intravenous minocycline : an antimicrobial stewardship approach at the Detroit Medical Center", Clin Infect Dis, 59(Suppl 6), pp.S388~S393 (2014)
- Batirel A, "Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections", Eur J Clin Microbiol Infect Dis, 33, pp.1311~1322 (2014)
- Young Ah Kim, "Epidemiology and treatment of antimicrobialresistant gram-negative bacteria in Korea", The Korean Journal of Internal Medicine, 33(2), pp.247~255 (2018), 대한내과학회[DOI]
- 배일권, "Carbapenem 내성 Acinetobacter baumannii", Annals of Clinical Microbiology, 15(1), pp.1~8 (2012), 대한임상미생물학회
- Park SY, "Early administration of appropriate antimicrobial agents to improve the outcome of carbapenem-resistant Acinetobacter baumannii complex bacteraemic pneumonia", Int J Antimicrob Agents, 51, pp.407~412 (2018)
- 이효진, "카바페넴 내성 장내세균: 최신지견과 치료전략", 대한의사협회지, 61(4), pp.281~289 (2018), 대한의사협회[DOI]
- Logan LK, "Carbapenem-resistant enterobacteriaceae : an emerging problem in children", Clin Infect Dis, 55, pp.852~859 (2012)
- Makris D, "Colistin versus colistin combined with ampicillin-sulbactam for multiresistant Acinetobacter baumannii ventilator-associated pneumonia treatment : an open-label prospective study", Indian J Crit Care Med, 22, pp.67~77 (2018)
- Hsu AJ, "Treatment of multidrug-resistant gram-negative infections in children", Clin Infect Dis, 58, pp.1439~1448 (2014)
- Clinical and Laboratory Standards Institute, "Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. CLSI document M100-S25", Clinical and Laboratory Standards Institute, ~ (2015)
- Skrupky LP, "A comparison of ventilator-associated pneumonia rates as identified according to the National Healthcare Safety Network and American College of Chest Physicians criteria", Crit Care Med, 40, pp.281~284 (2012)
- Mularoni A, "Outcome of transplantation using organs from donors infected or colonized with carbapenem-resistant gram-negative bacteria", Am J Transplant, 15, pp.2674~2682 (2015)
- 최승준, "다양한 질병의 환자들이 입원하는 소아 중환자실에서 PRISM III의 적용", Acute and Critical Care, 26(3), pp.123~127 (2011), 대한중환자의학회
- Ko KS, "Old drug, new findings : colistin resistance and dependence of Acinetobacter baumannii", Precis Future Med, 1, pp.159~167 (2017)
- 이경원, "Multidrug-Resistant Acinetobacter spp.: Increasingly Problematic Nosocomial Pathogens", Yonsei Medical Journal, 52(6), pp.879~891 (2011), 연세대학교의과대학
- 김묘징, "신생아 집중치료실에서 집단 발생한 Acinetobacter septicemia", Clinical and Experimental Pediatrics, 49(5), pp.494~499 (2006), 대한소아청소년과학회