Objective To evaluate the efficacy and safety of colistin in the treatment of severe infections. Methods PubMed, ISI Web of Knowledge and Wanfang databases were searched. The initial literatures and references listed in the literature were manually searched. Controlled studies were analyzed using RevMan 5. 0 software.Results Eleven studies were enrolled, including five prospective studies and six retrospective studies. Pooled analysis showed that, compared with other therapies, treatment with colistin in severe infections did not improve 28 or 30-day mortality, clinical symptoms, or bacteria clearance,however, increased the risk of kidney damage. Subgroup analysis showed that colistin did not improve symptoms, mortality ( which was even higher in the patients with drug resistant bacteria infection) , or kidney damage in drug resistant bacteria infections and ventilator associated pneumonia ( VAP) compared with the other antibiotic group. Conclusions Colistin is not superior to the other antibiotics in severe infections.However, there are some shortcomings in our meta-analysis due to limited high-quality RCTs, thus welldesigned RCTs are still needed before final conclusion is made.
Objective To review the clinical features and trend in antimicrobial resistance of Acinetobacter baumannii (A. baumannii) bloodstream infections. Methods Retrospective analysis was performed by collecting data of underlying diseases, potential risk factors, clinical characteristics, blood test results, Acute Physiology and Chronic Health EvaluationⅡ (APACHEⅡ) scores at onset, bacterial resistance to antibiotics and antimicrobial therapy were collected in Hunan Provincial People’s Hospital from January 2010 to June 2016. Results There were 114 non-duplicated A. baumannii complex blood isolates identified in this research. All patients had at least one underlying disease and accepted at least one surgery or invasive operation within the past 14 days. Multidrug-resistant A. baumannii (MDRAB) was isolated from 89 (78.1%) patients. Of the 114 strains of A. baumannii, 12.3% were resistant to tigecycline, 55.3% to amikacin and 61.4% to cefoperazone-sulbactam. The overall mortality was 51.8% (59/114). The patients with MDRAB had higher mortality rate than those with non-MDRAB (62.9% vs. 12.0%, χ2=20.268, P<0.001). With higher incidence of being in the intensive care unit, intubation/tracheotomy and increased APACHEⅡ score among patients with MDRAB bacteremia (P<0.05). Compared with subjects treated with tigecycline based regimen, those treated with non tigecycline for multidrug resistantA. baumannii had a higher mortality (64.8% vs. 60.0%) but there was no statistical significance (P>0.05). Conclusions The isolated A. baumannii are mainly multidrug resistant and with high mortality. Being in the intensive care unit, increased APACHEⅡ score and intubation/tracheotomy were risk factors for higher mortality among patients with MDRAB bloodstream infection. Tigecycline based regimen doesn’t improve patients’ prognosis.
Intracranial Acinetobacter baumannii infection is a rare clinical disease with a gradual increase in incidence and extremely high mortality. With the continuous enhancement of bacterial resistance, more and more intracranial infections of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii have appeared in the clinic, and its treatment has become a major challenge and problem faced by neurosurgeons. The treatment difficulties include the selection, usage and dosage of antimicrobial agents, as well as whether cerebrospinal fluid drainage is needed. A standardized treatment plan is still needed. In this paper, combining domestic and foreign literature, the treatment of intracranial infection of multidrug-resistant and extensively drug-resistant Acinetobacter baumannii will be reviewed in order to provide a reference for clinical treatment.
Objective To investigate the drug resistance and homogeneous analysis of Acinetobacter baumanii in emergency intensive care unit ( EICU) . Methods Four multidrug-resistant Acinetobacter baumannii ( MDR-Ab) strains isolated fromnosocomial inpatients fromJuly 25 to September 7 in 2009 were collected and tested for drug sensitivity and MIC determination as well. The A. baumannii isolates were typed with pulsed-field gel electrophoresis ( PFGE) to determine whether they derived fromthe same clone.Results Four isolates from nosocomial inpatients were resistant to multiple antibiotics including carbapenem. The PFGE types identified from four isolates were A and B. The A. baumannii isolates did not derived from the same clone. Conclusion The prevalence of nosocomial infection is not due to transmission of the same strains among different individuals in EICU.
There is a worldwide consensus that urgent action is needed to prevent and control multi-drug resistant organisms in health care settings, especially carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPsA). In 2017, to focus on this topic, World Health Organization organized experts worldwide to develop guidelines for the prevention and control of CRE, CRPsA and CRAB. In this paper, we introduced the background, development process, main measures, advantages and disadvantages of the guidelines to help infection prevention and control practitioners take actions properly based on the guidelines.
目的：对鲍曼不动杆菌感染的临床特征和耐药性进行分析，为临床诊治提供参考。方法：对2005年1月～2006年6月我院临床分离的共107株鲍曼不动杆菌通过琼脂对倍稀释法进行MIC测定；同时对相应的临床病例进行回顾性分析。结果：107株鲍曼不动杆菌大多分离自痰液，主要来自于ICU病房；且91.59%的患者同时存在2种以上基础疾病。鲍曼不动杆菌对氨曲南耐药率最高，为89.72%，依次是头孢西丁(87.85%)，头孢哌酮(76.64%)、哌拉西林(69.16%)、头孢噻肟(65.42%)、环丙沙星(65.42%)、阿米卡星(56.07%)、头孢他定(5514%)等。结论：我院鲍曼不动杆菌耐药情况严重，治疗首选碳青霉烯类抗生素，其次可选用头孢吡肟、头孢哌酮/舒巴坦。
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.
ObjectiveTo explore the infection condition of Acinetobacter baumannii at the Neurosurgery Intensive Care Unit (NICU), and analyze the possible risk factors. MethodsWe retrospectively analyzed the clinical data of Acinetobacter baumannii infection patients with craniocerebral injury treated at the NICU between January 2011 and June 2013. We collected such information as infection patients' population distribution, infection site, invasive operations and patients' nurse-in-charge level and so on, and analyzed the possible risk factors for the infection. ResultsThirty-one patients were infected with Acinetobacter baumannii, and they were mainly distributed between 60 and 80 years old. The main infection site was lower respiratory tract, followed in order by urinary tract, gastrointestinal tract, skin and soft tissue. The risk factors might be related to age, invasive operation, nurse working ability, etc. ConclusionThe patients at the NICU are vulnerable to infection of Acinetobacter baumannii. Reducing invasive diagnosis and nursing procedures, providing optimal care, and carrying out specialized nurse standardization training may be the important means to effectively reduce the infection.
ObjectiveTo explore the prognostic risk factors of bloodstream infections caused by Acinetobacter baumannii in the hospital, to provide a basis for clinical diagnosis and treatment.MethodsA retrospective analysis was performed on the medical records of patients diagnosed with Acinetobacter baumannii bloodstream infection in Guangxi Zhuang Autonomous Region People’s Hospital between January 2013 and December 2018. The patients were divided into survival group and non-survival group according to the outcome within 30 days after blood culture was collected. Univariate and multivariate logistic analyses were used to identify the risk factors of Acinetobacter baumannii bloodstream infections.ResultsA total of 123 patients were included, including 48 in the survival group and 75 in the non-survival group. Third generation cephalosporins [odds ratio (OR)=2.492, 95% confidence interval (CI) (2.125, 2.924), P<0.001], carbapenems [OR=1.721, 95%CI (1.505, 1.969), P<0.001], multidrug resistant-Acinetobacter baumannii infection [OR=1.240, 95%CI (1.063, 1.446), P=0.006], post-operation [OR=0.515, 95%CI (0.449, 0.590), P<0.001], mechanical ventilation [OR=1.182, 95%CI (1.005, 1.388), P=0.043], indwelling central venous catheter [OR=0.116, 95%CI (0.080, 0.169), P<0.001], mixed infection or septic shock [OR=3.935, 95%CI (2.740, 5.650), P<0.001], APACHE Ⅱ score (≥15) [OR=5.939, 95%CI (5.029, 7.013), P<0.001], chronic kidney disease [OR=1.440, 95%CI (1.247, 1.662), P<0.001], immune system disease [OR=28.620, 95%CI (17.087, 47.937), P<0.001], use of corticosteroids [OR=0.520, 95%CI (0.427, 0.635), P<0.001], and combined antifungal agents [OR=0.814, 95%CI (0.668, 0.992), P=0.041] were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii.ConclusionsThe third generation cephalosporins, carbapenem, MDR-Acinetobacter baumannii infection, post-operation, mechanical ventilation, indwelling central venous catheter, mixed infection or septic shock, APACHE Ⅱ score (≥15), chronic kidney disease, immune system disease, use of corticosteroids, and combined antifungal agents were independent factors for predicting the prognosis of patients with bloodstream infections caused by Acinetobacter baumannii. In the clinical work, it is needed to carry out timely detection of microbial etiology, timely report, and reasonable treatment.