多粘菌素B治疗碳青霉烯耐药菌所致中枢神经系统感染的三种方案比较：一项回顾性队列研究

IF 4 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-07-16 DOI:10.1016/j.jiph.2025.102903

Xuan Leng , Lexin Xia , Hui Zhou , Chunlu Cheng , Chunfang Cui , Jingyan Xia , Feng Xu

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引用次数: 0

摘要

碳青霉烯耐药生物引起的中枢神经系统感染患病率呈上升趋势，对公众健康构成越来越大的威胁。多粘菌素被认为是“最后的选择”之一。在本研究中，我们分析了多粘菌素B三种给药方案的治疗效果：静脉注射（IV），脑室注射（IVT）或鞘内注射（ITH）（表示为IVT/ITH），静脉注射联合IVT或ITH（表示为联合治疗）。方法回顾性研究在浙江大学医学院第二附属医院进行。IV组53例，IVT/ITH组71例，联合组106例。记录了患者的临床特点、治疗过程及相关检查结果。结果临床转归（分为临床成功、临床缓解和临床失败）、脑脊液（CSF）病原体清除率和28天全因死亡率是三个主要评价标准。在临床结果方面，IV组优于IVT/ITH组（P = 0.032）和联合组（P = 0.008）。联合用药组CSF病原体清除率优于静脉注射组（P = 0.001）和静脉注射/ITH联合用药组（P = 0.041）。IVT/ITH组28天全因死亡率（P = 0.018）和联合组（P = 0.004）均低于IV组。多因素logistic回归分析显示，多粘菌素B的给药途径与28天全因死亡率相关（P = 0.001）。结论IVT/ITH和IVT/ITH联合使用多粘菌素B可有效降低死亡率，取得更好的临床效果，而联合方案在根除脑脊液病原体方面效果更好。

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The comparison of three regimens of polymyxin B for the treatment of central nervous system infections caused by carbapenem-resistant bacteria: A retrospective cohort study

Background

The prevalence of central nervous system infections caused by carbapenem-resistant organisms is on the rise, posing a growing threat to public health. Polymyxin is deemed as one of the “last resort” options. In this study, we analyzed the therapeutic efficacy of three dosing regimens of polymyxin B: intravenous (IV), intraventricular (IVT) or intrathecal (ITH) (denote as IVT/ITH), and IV combined with IVT or ITH (denote as combination therapy).

Methods

The retrospective study was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine. There were 53 patients in the IV group, 71 in the IVT/ITH group, and 106 in the combination group. The clinical characteristics, treatment process, and the results of relevant tests were documented.

Results

Clinical outcome (classified as clinical success, clinical relief and clinical failure), cerebrospinal fluid (CSF) pathogen clearance rate, and 28-day all-cause mortality were the three primary evaluation criteria. Concerning the clinical outcome, the IV group was inferior to the IVT/ITH (P = 0.032) and the combination group (P = 0.008). The CSF pathogen clearance rate of the combination group was superior to that of the IV group (P = 0.001) and the IVT/ITH group (P = 0.041). The 28-day all-cause mortality was lower in the IVT/ITH group (P = 0.018) and the combination group (P = 0.004) compared to the IV group. Multivariate logistic regression analysis demonstrated that the route of delivery of polymyxin B was associated with 28-day all-cause mortality (P = 0.001).

Conclusions

The IVT/ITH and IV combined with IVT/ITH use of polymyxin B can effectively reduce mortality and achieve better clinical outcomes, while the combination regimen performed better in eradicating CSF pathogens.

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.