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OBJECTIVE： To study the efficacy and economics of cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with multidrug-resistant Acinetobacter baumannii （MDRAB）. METHODS： By prospective study， 150 MDRAB pneumonia patients were selected from Jingmen Second People’s Hospital during Jan. 1st， 2016-Aug. 31st， 2019， and then randomly divided into control group and observation group， with 75 cases in each group. Control group was given Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Tigecycline for injection （first dose 100 mg， maintenance dose 50 mg， q12 h， ivgtt）. Observation group was give Cefoperazone/sulbactam sodium for injection （3 g， q8 h， ivgtt） combined with Moxifloxacin hydrochloride and sodium chloride injection （400 mg， qd， ivgtt） and Amikacin sulfate injection （0.6 g， qd， ivgtt）. The treatment lasted for 14 days in both groups. The time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal， clinical efficacy， bacterial clearance rate and the occurrence of ADR were compared between 2 groups. Cost-effectiveness analysis was used to evaluate the cost- effectiveness ratio （C/E） and incremental cost-effectiveness ratio （ΔC/ΔE） of 2 groups using antibiotics cost as cost. Sensitivity analysis was performed by reducing drug cost by 15％. RESULTS： There was no statistical significance in the time for body temperature to return to normal， lung rales disappearance， WBC to return to normal and PCT to return to normal between control group and observation group （P＞0.05）. Clinical response rates of 2 groups were 85.33％ and 81.33％， and bacterial clearance rate were 89.33％ and 82.67％， with statistical significance （P＞0.05）. No serious ADR occurred in either group. The antibacterial cost of control group and observation group were 32 371.49 yuan/person and 9 367.82 yuan/person. C/E of clinical response rate were 379.37 and 115.18， and C/E of bacterial clearance rate were 362.38 and 113.32 in 2 groups， respectively. ΔC/ΔE of clinical response rate and bacterial clearance rate between control group and observation group were 5 750.92 and 3 454.00. Sensitivity analysis supported cost-effectiveness analysis results. CONCLUSIONS： Cefoperazone/sulbactam combined with moxifloxacin and amikacin versus cefoperazone/sulbactam combined with tigecycline in the treatment of pneumonia with MDRAB has similar efficacy， but cefoperazone/sulbactam combined with moxifloxacin and amikacin has economic and social benefits.
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Objective To obtain knowledge of microbial colonial structures and epidemic strains of clinically isolated multidrug-resistant Acinetobacter baumannii in Anhui in recent years.To analyze gene homologies and phylogenetic relationships of multidrug-resistant Acinetobacter baumannii.To provide some laboratory data for clinical antimicrobial application.Methods Eighty-seven strains of clinically isolate dmultidrug-resistant Acinetobacter baumannii were collected in this study,and the minimal inhibitory concentrations of these strains to 11 common antimicrobials were measured by agar dilution.Evolutionary relationships between the strains were revealed with employment of multilocus sequence typing,and clustering figures were constructed with the aid of the BioNumerics software,thus enabling genotyping.Results The drug-resistance rates of 87 strains of Acinetobacter baumannii to imipenem and meropenem were 74.7％ and 66.7％,respectively,while the drug-resistance rates to other antimicrobials were considerably high.All the 87 strains were sub-divided into 42 ST-types,6 of which were already involved in the database while 36 (temporarily named STnew01 ～STnew36) were newly established.Thirty-seven strains were proved dominant types and sub-listed in the ST2 category.The ST2 Acinetobacter baumannii belongs to the clone complex CC1.Conclusion All multidrug-resistant Acinetobacter baumannii in research show high drug-resistance rates when treated with 11 common antimicrobials.The ST2 category is the principal epidemic clones of multidrug-resistant Acinetobacter baumannii in Anhui province,and a highly recogonizable homology is observed between the principal epidemic strains(ST2) in Anhui and those in the world.
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Objective To confirm the species of multidrug-resistant Acinetobacter baumannii (MRAB)strains collected from our hospital by specific PCR amplification,and further investigate their distribution,antibiotic resistance and molecular classification characteristics.Methods We collected 47 MRAB clinical strains which had been identified by VITEK-2 system,followed by species confirmation using specific primers sp2F,sp4F and sp4R through PCR amplification.Antibiotic resistance characteristics were detected using VITEK-2 system.And the homology of MRAB isolates was analyzed using multilocus sequence typing (MLST).Results We confirmed 46 out of 47 strains as A .baumannii .All of them were multidrug-resistant strains,and the majority of them were found in sputum samples from patients in intensive care units (ICUs).MLST analysis found 4 ST types,namely ST195,ST218,ST368 and ST208.The last two types had the closest genetic relationship.Conclusion SpecificPCR amplification is a rapid and accurate method to identify A .baumannii .The MRAB strains in our hospital are mainly distributed in ICUs and are susceptible to only a few antibiotics such as tigecycline.
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Objective To confirm the species of multidrug-resistant Acinetobacter baumannii (MRAB)strains collected from our hospital by specific PCR amplification,and further investigate their distribution,antibiotic resistance and molecular classification characteristics.Methods We collected 47 MRAB clinical strains which had been identified by VITEK-2 system,followed by species confirmation using specific primers sp2F,sp4F and sp4R through PCR amplification.Antibiotic resistance characteristics were detected using VITEK-2 system.And the homology of MRAB isolates was analyzed using multilocus sequence typing (MLST).Results We confirmed 46 out of 47 strains as A .baumannii .All of them were multidrug-resistant strains,and the majority of them were found in sputum samples from patients in intensive care units (ICUs).MLST analysis found 4 ST types,namely ST195,ST218,ST368 and ST208.The last two types had the closest genetic relationship.Conclusion SpecificPCR amplification is a rapid and accurate method to identify A .baumannii .The MRAB strains in our hospital are mainly distributed in ICUs and are susceptible to only a few antibiotics such as tigecycline.
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OBJECTIVE:To observe clinical efficacy and safety of tigecycline combined with isepamicin in the treatment of multidrug-resistant Acinetobacter baumannii pneumonia. METHODS:70 patients diagnosed as multidrug-resistant A. baumannii pneumonia were selected and randomly divided into control group and observation group,with 35 cases in each group. Both groups received routine treatment oxygen therapy or mechanical ventilation,anti-hypertension,hypoglycemic therapy. Control group was given Cefoperazone sulbactam for injection 3 g added into Sodium chloride injection 100 ml,ivgtt,qid. Observation group re-ceived Tigecycline for injection 100 mg,decreasing to 50 mg added into Sodium chloride injection 250 ml,ivgtt,bid,combined with Isepamicin sulfate injection 400 mg added into Sodium chloride injection 250 ml,ivgtt,qd. The time of body temperature re-turn to normal,pulmonary rale disappearance,chest X-ray shadow disappearance and leucocyte return to normal were observed in 2 groups as well as serum inflammatory factor level before and after treatment;total effective rate,bacterial clearance rate and ADR were compared between 2 groups. RESULTS:The time of body temperature return to normal,pulmonary rale disappearance, chest X-ray shadow disappearance and leucocyte return to normal in observation group were significantly shorter than in control group,with statistical significance(P0.05). The serum inflammatory factor of 2 groups decreased significantly after treatment,and the observation group was significantly lower than the control group,with statistical significance(P0.05). CONCLUSIONS:Tigecycline combined with isepamicin is effective for multidrug-resistant A. baumannii pneu-monia,and can improve clinical symptom,control inflammation reaction,having high sterilization with good safety.
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OBJECTIVE: To evaluate the antibiotic effects in vitro of colistin combined with other antibacterials respectively against 73 strains of multidrug-resistant Acinetobacter baumannii (MDR-Ab). METHODS: The protocol was designed by checkerboard method and the MICs of drugs alone and combination against the 73 strains of Acinetobacter baumannii were determined by broth dilution method, the FIC index was calculated according to MIC results. The interaction was measured by the fractional inhibitory concentration index (FIC): antagonism was defined as FICI≥4, indifference as 1
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Objective To evaluate the clinical efficacy of tigecycline combinated with isepamicin for treatment of pneumonia caused by multidrug-resistant Acinetobacter baumannii.Methods A retrospective analysis was performed in adult patients with multidrug-resistant Acinetobacter baumannii pneumonia in two general hospitals from January 2012 to January 2014.Total eighty-four patients with MDR-Acinetobacter baumannii pneumonia were randomly divided into two groups(n=42).One group was treated with tigecycline combinated with isepamicin(termed combination therapy group),and another group was administrated with cefoperazone sulbactam (termed control group ).The clinical cure rates,microbiological eradication rates and adverse events were collected and compared. Results There was no difference in APACHEⅡ score between two groups.The clinical cure rates in combination therapy group was significantly higher than that in control group(88% vs 61%,P<0.05),and with a higher rate of microbiological eradication(59.5% vs 35.7%,P <0.05 ).However,the occurence rate of adverse events was similar in the two groups (7.1% vs 1 1.9%). Conclusion With a higher rate of clinical efficacy and a lower rate of adverse events,the combination therapy with tigecycline and isepamicin would be a promising alternative for treatment with MDR-Acinetobacter baumannii pneumonia.
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Multidrug-resistant (MDR) Acinetobacter baumannii is a worldwide concern as cause of serious nosocomial infections. We analysed 140 non-duplicate Acinetobacter sp. isolates from hospitalised patients in a tertiary care centre; 87% were MDR and 20% (28/140) meropenem resistant. Metallo-β-lactamase was produced by 16 of these, detected by ethylene-diamine-tetra-acetic acid disc synergy test. AmpC β-lactamase and efflux pump were present in 17 and 4 of the meropenem-resistant Acinetobacter, respectively. 9/16 MBL-positive isolates carried genes for carbapenem resistance as shown by polymerase chain reaction.
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While broad-spectrum antibiotics are widely used in these years,multidrug-resistant,extensively drug resistant,even pan drug resistant bacteria arise constantly.Acinetobacter baumannii is a common conditioned pathogen,and multidrug-resistant acinetobacter baumannii (MDRAB) has become one of the trickiest problems in nosocomial infection.The resistant mechanism of MDRAB include:producing antimicrobial inactivator,changing target site or cell function,adventitia barrier and effiux pump.Currently,sulbactam,carbapenem,polymyxin,tetracycline and some other antibiotics are used in MDRAB infection.Since lacking of extensive clinic study,there is no guideline up to now,the experience is especially less in pediatrics.
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This study aimed to investigate whether CHROMagar Acinetobacter medium (CHROMagar, France) in combination with an antimicrobial supplement (modified CHROMagar Acinetobacter; CHROMagar, France) can be used for detecting and isolating multidrug-resistant Acinetobacter species (MRA) in nasal and rectal surveillance cultures. Nasal and rectal swab samples were collected from patients in an intensive care unit at a teaching hospital. The samples were used to inoculate modified CHROMagar Acinetobacter plates, which were examined after 24 and 48 hr of incubation at 37degrees C. Their susceptibility against the antimicrobial agents meropenem, imipenem, ciprofloxacin, and amikacin was analyzed using the Etest (bioMerieux, France). A total of 406 paired samples (406 nasal swabs and 406 rectal swabs) were obtained from 226 patients, and 120 samples (28 nasal and 28 rectal cultures, 47 nasal cultures only, and 17 rectal cultures only) yielded MRA. Seventy-five MRA isolates (18.5%) were recovered from the 406 nasal samples, and 45 MRA isolates (11.1%) were recovered from the 406 rectal samples. Of the 120 MRA isolates, 3 (2.5%) were detected only after 48 hr of incubation. The use of modified CHROMagar Acinetobacter together with nasal and rectal swabs and 1-day incubation is an effective surveillance tool for detecting MRA colonization.
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Humanos , Acinetobacter/efeitos dos fármacos , Infecções por Acinetobacter/diagnóstico , Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana , Nariz/microbiologia , Kit de Reagentes para Diagnóstico , Reto/microbiologiaRESUMO
This study aimed to investigate whether CHROMagar Acinetobacter medium (CHROMagar, France) in combination with an antimicrobial supplement (modified CHROMagar Acinetobacter; CHROMagar, France) can be used for detecting and isolating multidrug-resistant Acinetobacter species (MRA) in nasal and rectal surveillance cultures. Nasal and rectal swab samples were collected from patients in an intensive care unit at a teaching hospital. The samples were used to inoculate modified CHROMagar Acinetobacter plates, which were examined after 24 and 48 hr of incubation at 37degrees C. Their susceptibility against the antimicrobial agents meropenem, imipenem, ciprofloxacin, and amikacin was analyzed using the Etest (bioMerieux, France). A total of 406 paired samples (406 nasal swabs and 406 rectal swabs) were obtained from 226 patients, and 120 samples (28 nasal and 28 rectal cultures, 47 nasal cultures only, and 17 rectal cultures only) yielded MRA. Seventy-five MRA isolates (18.5%) were recovered from the 406 nasal samples, and 45 MRA isolates (11.1%) were recovered from the 406 rectal samples. Of the 120 MRA isolates, 3 (2.5%) were detected only after 48 hr of incubation. The use of modified CHROMagar Acinetobacter together with nasal and rectal swabs and 1-day incubation is an effective surveillance tool for detecting MRA colonization.