藥學(xué)專業(yè)畢業(yè)論文外文翻譯--亞胺培南與多粘菌素相比在治療呼吸機相關(guān)性肺炎的安全性和有效性（英文）

1、Intensive Care Med (2007) 33:1162–1167 DOI 10.1007/s00134-007-0675-2 ORIGINALH. Kallel L. Hergafi M. Bahloul A. Hakim H. Dammak H. Chelly C. Ben Hamida A. Chaari N. Rekik M. BouazizSafety and efficacy of colistin compare

2、d with imipenem in the treatment of ventilator-associated pneumonia: a matched case–control studyReceived: 26 July 2006 Accepted: 23 April 2007 Published online: 25 May 2007 © Springer-Verlag 2007H. Kallel (u) ·

3、; L. Hergafi · M. Bahloul · H. Dammak · H. Chelly · C. B. Hamida · A. Chaari · N. Rekik · M. Bouaziz CHU Habib Bourguiba, Service de Réanimation Médicale, route el Ain Km 1, 3

4、029 Sfax, Tunisia e-mail: kallelhat@yahoo.fr Tel.: +216-98-41-52 99 Fax: +216-74-24-34 27A. Hakim Faculté de Médecine de Sfax, Laboratoire de Pharmacologie, route el Ain Km 1, 3029 Sfax, TunisiaAbstract Objecti

5、ve: Our study aimed to determine the efficacy and safety of colistin in the treatmentof ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acineto- bacter baumanii. Design: Pairw

6、ise, retrospective exposed–unexposed study. Setting: Combined medical and surgical intensive care unit of Habib Bourguiba University Hos- pital (Sfax, Tunisia). Patients: Sixty patients with VAP caused by pan-drug-resist

7、ant A. baumanii or P. aeruginosa matched to 60 controls with VAP caused by A. baumanii or P. aeruginosa susceptible to imipenem. All patients had normal renal function at the onset of antibiotic therapy. Interventions: C

8、ase patients were treated by colistin intravenously and control patients were treated by imipenem intravenously. Meas- urements and results: Baseline characteristics were similar between the colistin and imipenem groups.

9、 The mean duration of antibiotictherapy for VAP was 9.5 ± 3.8 days (range 5–22 days) with colistin and 8.9 ± 2.8 days (range 5–20 days) with imipenem (p = 0.32). A favor- able clinical response to antibiotic th

10、erapy for VAP occurred in 45 pa- tients (75%) in the colistin group and in 43 patients (71.7%) in the imipenem group (p = 0.68). The time to resolution of infectious parame- ters after the initiation of antibiotic therap

11、y was not statistically different between the two groups. During the antibiotic course, none of the patients in either group developed renal fail- ure. Conclusions: We conclude that colistin can be a safe and effective o

12、ption in the treatments of VAP caused by pan-drug-resistant P. aeruginosa or A. baumanii.Keywords Colistin · Ventilator- associated pneumonia · Nephro- toxicity · ImipenemIntroductionPan-drug-resistant (PD

13、R) gram-negative bacteria are an important problem worldwide, especially in the intensive care unit (ICU) [1, 2]. Multiple drug resistance makes difficult the choice of the empiric antimicrobial molecule and is responsib

14、le for delayed adapted antimicrobial treatment [3]. In the recently published literature, Pseudo- monas aeruginosa and Acinetobacter baumanii are the two most widely described microorganisms to be resistantto the most of

15、 available antibiotics [4]. For this reason, colistin has been recently considered as a last therapeutic option for the treatment of patients with infections caused by these microorganisms [4].Colistin is an old antibiot

16、ic which was used until theearly 1980s to treat infections caused by gram-negative rods. When gentamicin and second- and third-generation cephalosporins became available, colistin was dropped, mainly because of its neuro

17、- and nephrotoxicity [5–8]. The increasing prevalence of PDR gram-negative organisms,1164Treatment regimenIn the colistin group, patients were treated with colistin sulfomethate sodium (Bellon; Rhône-Poulenc Rorer)

18、administered intravenously. The dosage was 6 million units (≈ 100,000 U/kg) of colistin daily, divided into three doses. In the imipenem group, patients were treated with imipenem (imipenem/cilastatin; MSD) administered

19、intravenously. The dosage was 2 g of imipenem daily, divided into four doses. In this study, all patients received colistin or imipenem on an empirical basis, which made the initial antibiotic treatment appropriate in al

20、l cases.Statistical analysisCategorical variables were expressed as percentages and continuous variables as mean values (SD). Percentages were compared using the chi-square test and means with the t-test. The Wilcoxon ma

21、tched pairs test was used to compare the matching criteria (age, SAPS II, and PaO2/FiO2). Kaplan–Meier curves were used to assess differences between the colistin group and the imipenem group in (1) resolution of infecti

22、ous parameters after the initiation of antibiotic therapy and (2) mortality at 28 days after the onset of colistin or imipenem therapy for VAP. Curves were compared using the log-rank test. A p value ≤ 0.05 in a two-tail

23、ed test was considered to indicate statistical significance.ResultsDuring the study period, 1,208 patients were admitted to the unit. One thousand and seventy six of them (89.1%) re-Table 1 Matching criteria of the study

24、 populationColistin group (n = 60) Imipenem group (n = 60) p Effectiveness of matchingAge (years) 43.4 ± 18.8 41.4 ± 16.7 0.60 100%SAPS 35.2 ± 12.3 33.2 ± 10.8 0.35 100%PaO2/FiO2 on day of initiation

25、of antibiotics 213 ± 79 215 ± 81 0.87 100%Table 2 Baseline characteristics of the study populationColistin group (n = 60) Imipenem group (n = 60) pReason for admission n (%)Acute respiratory failure 7 (11.7) 8

26、(13.3) 0.78Coma 8 (13.3) 4 (6.6) 0.22Multiple trauma 42 (70) 48 (80) 0.20Postoperative resuscitation 3 (5) 0 (0) 0.24Sex ratio (male/female) 6.5 4.45 0.45Shock n (%) 18 (30) 14 (23.3) 0.40Antibiotics n (%) 46 (76.7) 39 (

27、65) 0.16PaO2/FiO2 at admission 311 ± 82 313 ± 84 0.9Urea nitrogen (mmol/l) 5.9 ± 1.9 6.4 ± 2.0 0.18Serum creatinine (µmol/l) 79.7 ± 17.8 82.0 ± 15.4 0.46ceived mechanical ventilation an

28、d 123 (11.4%) developed VAP. In 78 (63.4%) of these patients the VAP caused by PDR A. baumanii or P. aeruginosa and was treated with colistin. Of these 78 patients potentially eligible as cases, 12 were excluded because

29、of renal failure at the onset of colistin therapy. Of the 66 remaining case patients enrolled in the study, matching was possible for only 60 (90.9%).All patients were matched for age, SAPS II, andPaO2/FiO2 at the onset

30、of antibiotic therapy for VAP. Overall success of matching was achieved in 100% of the variables used (Table 1). Baseline characteristics of the study population are shown in Table 2.In the colistin group, 51.7% of cases

31、 of VAP werecaused by A. baumanii and 48.4% by P. aeruginosa. In all patients in this group, A. baumanii and P. aeruginosa were PDR and were susceptible only to colistin. In the imipenem group, 61.7% of cases of VAP were

32、 caused by A. baumanii and 38.3% by P. aeruginosa. In all patients in this group, A. baumanii and P. aeruginosa were resistant to penicillins and third-generation cephalosporins and susceptible to imipenem.The mean ICU s

33、tay before the initiation of antibiotictherapy for the VAP was 13 ± 10 days (range 5–43 days) in the colistin group and 11 ± 9 days (range 5–38 days) and the imipenem group (p = 0.24). The mean duration of anti

34、biotic therapy for VAP was 9.5 ± 3.8 days (range 5–22 days) and 8.9 ± 2.8 days (range 5–20 days) respec- tively (p = 0.32). Eight patients in the colistin group and 9 patients in the imipenem group received ant

35、ibiotics (col- istin or imipenem) for less than 10 days because they died during the course of therapy. A favorable clinical response to antibiotic therapy for VAP occurred in 45 patients (75%) in the colistin group and