Combination Antibiotics for Gram-negative Bacteria in Patients with Healthcare-associated or Hospital-acquired Pneumonia with Severe Sepsis or Septic Shock

嚴重革蘭氏陰性病菌健康照護相關／院內肺炎病人的聯合抗生素使用

吳黃平(Huang-Pin Wu) ； 黃志宇(Chih-Yu Huang) ； 朱建民(Chien-Ming Chu) ； 于鍾傑(Chung-Chieh) ； 花仲涇(Chung-Ching Hua) ； 游騰仁(Teng-Jen Yu) ； 劉育志(Yu-Chih Liu)

《內科學誌》 27卷2期 (2016/04) Pp. 89-96

https://doi.org/10.6314/JIMT.2016.27(2).05

摘要

治療指引建議一開始經驗性使用兩種抗生素治療院內及健康照護相關肺炎。傳統抗菌圖譜無法提供適當訊息，告訴我們最佳合併治療藥物。因此我們做了一個觀察性的研究來探討哪種合併治療是適當的。從2007年七月到2010年六月，因為健康照護相關肺炎或院內肺炎合併嚴重敗血症，而入住基隆長庚醫院內科加護病房的病人，都會被此研究收進來篩檢。病患的臨床特徵及病菌藥物敏感結果都會被記錄。一共有117位病患符合收錄及排除條件。最常被採撿到的病菌是綠膿桿菌、鮑氏不動桿菌、肺炎克雷伯氏菌及大腸桿菌。以單一抗生素治療來說，對革蘭氏陰性病菌藥物敏感度最高的是泰寧®，76.1%有效。以合併抗生素治療來說，藥物敏感度最高的組合是以泰寧®為基礎，合併阿米卡星、慶大霉素、速博新或可樂必妥®，敏感度增加6.8%達到82.9%；藥物敏感度第二高的組合是特治星®加上阿米卡星，有76.9%。因此，在這個研究中，合併抗生素治療最佳選擇是泰寧®加上速博新或可樂必妥®，因為可以涵蓋最多革蘭氏陰性病原菌。

並列摘要

Guidelines suggest that patients with multiple drug resistance pathogen-related hospital-acquired pneumonia (HAP) or healthcare-associated pneumonia (HCAP) should initially be prescribed with two empiric antibiotics for gram-negative pathogens. Traditional antibiograms cannot provide information about which combination therapy is the best choice. We therefore conducted this observational study to determine which combination of antibiotics is optimal. From July 2007 to June 2010, patients who were admitted to the medical intensive care unit at Chang Gung Memorial Hospital, Keelung due to HCAP or HAP with severe sepsis or septic shock were screened in this study. The clinical characteristics and antimicrobial resistance profiles were analyzed. A total of 117 patients who met the inclusion and exclusion criteria were enrolled for analysis. The most frequently isolated pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. In monotherapy, the highest susceptibility to gram-negative bacteria was 76.1% with imipenem/cilastatin. In combination therapy, the highest susceptibility was 82.9% with a 6.8% additional advantage with a base of imipenem/cilastatin with amikacin, gentamicin, ciprofloxacin, or levofloxacin. The secondary highest susceptibility in combination therapy was 76.9% with piperacillin/tazobactam and amikacin. Thus, the first choice of combination therapy in this study was imipenem/cilastatin combined with ciprofloxacin or levofloxacin, which covered the most pathogens.

並列關鍵字

Hospital-acquired pneumonia ； Healthcare-associated pneumonia ； Combination therapy