Colistin之臨床應用於多重抗藥性菌再評估

Re-Evaluation of the Clinical Application of Colistin to Multidrug-Resistant Bacteria

林旭志(Hsu-Chih Lin) ； 張秀芳(Hsiu-Fang Chang) ； 鄭清連(Cing-Lian Jheng) ； 劉彥吟(Yen-Yin Liu) ； 陳子殷(Tzu-Yin Chen) ； 吳錦生(Chin-Sheng Wu)

《臺灣臨床藥學雜誌》 21卷1期 (2013/03) Pp. 15-21

https://doi.org/10.6168/FJCP.2013.2101.02

摘要

本研究以回溯性分析某區域教學醫院自2011年1月至5月間接受colistin治療的住院病患。評估病患接受治療後30天的存活率、臨床適應症、用法／用量、療效及副作用。共收案33名患者（男性22名，女性11名），平均年齡78.5 ± 12.4歲。其中13名（39.4%）達成30天存活率，19名（57.6%）病危出院或死亡，1名（3%）因轉院而無法評估。患者疾病之嚴重度及年齡也會影響30天存活率的評估。患者感染症為肺炎（28名，84.8%）、敗血症（4名，12.1%）、泌尿道感染（1名，3.0%）；細菌報告有28名（84.8%）為多重抗藥性鮑氏不動桿菌（multidrug-resistant Acinetobacter baumannii, MDRAB）；平均用藥天數13.8 ± 5.2 天。13名（39.4%）使用霧化吸入（劑量皆為66.8 mg q12h）；靜脈注射有20名（60.6%），其中5名腎功能正常者用66.8 mg q8h、10名腎功能正常者用66.8 mg q12h、3名腎功能異常者減少給藥頻率，用66.8 mg qd、2位腎功能異常者減半劑量，用33.4mg q12h。患者中有7名之Crea值呈上升（21.2%），其中靜脈注射5名（25%）、霧化吸入2名（15.4%），兩者的副作用並無顯著性差異。患者中有21名（63.6%）達到治療效果或改善。研究顯示colistin是治療碳青黴烯抗藥性鮑氏不動桿菌（carbapenem-resistant Acinetobacter baumannii, CRAB）和其他高度抗藥性細菌的重要抗生素，雖已被設定為後線的管制性抗生素，但唯有在有效的管理下使用，才能遏止各類抗生素抗藥性菌株的出現。

關鍵字

多重抗藥性鮑氏不動桿菌（MDRAB） ； 碳青黴烯抗藥性鮑氏不動桿菌（CRAB）

並列摘要

The aims of this retrospective study were to assess the clinical medication use of colistin in a regional teaching hospital. A total 33 hospitalized patients with infections was included, 28 patients with pneumonia (84.8%), 4 with sepsis (12.1%), and 1 with urinary tract infection (3.0%). The 30-day survival rate was 39.4% (13), 19 patients (57.6%) were discharged in critical condition or death, and 1 (3%) could not be assessed due to transfer. The disease severity and patient age also affected the 30-day survival rate. The bacterial cultures showed 28 patients (84.8%) were infected from multidrug-resistant Acinetobacter baumannii (MDRAB). The average medication was 13.8 ± 5.2 days. Thirteen patients (39.4%) were given by aerosolized inhalation (dose: 66.8 mg q12h); 20 (60.6%) were given intravenously wherein 5 of normal renal function at the dose 66.8 mg q8h, 10 of normal renal function at 66.8 mg q12h, 3 of renal dysfunction at 66.8 mg qd, and 2 of renal dysfunction at 33.4 mg q12h. The Crea values of 7 patients (21.2%) were elevated, intravenous injection of 5 (25%) and aerosolized inhalation of 2 (15.4%). Side effects are not different significantly. Twenty one patients (63.6%) were cured or improved. Carbapenem-resistant Acinetobacter baumannii (CRAB) and other highly resistant bacteria have shown susceptibility to colistin in this study, Though it has been currently set to as a final-line controlled antibiotic, it should be used under the effective management in order to prevent the emergence of various types of antibiotic-resistant strains.

並列關鍵字

Colistin ； Multidrug-Resistant Acinetobacter baumannii (MDRAB) ； Carbapenem-Resistant Acinetobacter baumannii (CRAB)