اثربخشي درمان تركيبي كليستين و ريفامپين در بيماران مبتلا به پنوموني وابسته به ونتيلاتور ناشي از آسينتوباكتر بائوماني مقاوم به ايمي‌پنم: گزارش كوتاه

Efficacy of colistin and rifampin combination for treatment of ventilator associated pneumonia caused by carbapenem resistant Acinetobacter baumannii: brief report

زمينه و هدف: درمان عفونت‌هاي ناشي از آسينتوباكتر بائوماني به‌علت مقاومت‌هاي دارويي چندگانه مشكل است. هدف اين مطالعه تعيين اثربخشي درمان تركيبي كليستين و ريفامپيسين در درمان پنوموني وابسته به ونتيلاتور به‌علت آسينتوباكتر بائوماني مقاوم به ايمي‌پنم مي‌باشد. روش بررسي: در يك مطالعه تحليلي از آبان 1393 تا خرداد 1394 تعداد 50 بيمار در مركز آموزشي درماني وليعصر (عج) اراك تحت درمان استاندارد با كليستين و ريفامپين قرار گرفتند و متغيرهاي باليني آناليز گرديدند. يافته‌ها: 31 بيمار (62%) بيمار پس از درمان تركيبي بهبود يافتند، چهار بيمار (8%) در اثر عفونت و 15 بيمار (30%) به‌دلايل ديگر فوت كردند. ميانگين ميزان نيتروژن اوره خون و كراتينين به‌طرز معناداري افزايش داشت و تب، فشارخون، شمارش گلبول‌هاي سفيد، شمارش افتراقي و مورتاليتي كاهش پيدا كردند. نتيجه‌گيري: كليستين و ريفامپين يك تركيب ايمن و موثر در درمان پنوموني وابسته به ونتيلاتور ناشي از ايزوله‌هاي آسينتوباكتر بائوماني مقاوم به ايمي‌پنم است.

Background: It is difficult to treat infections caused by Acinetobacter baumannii due to multiple drug resistance. The aim of this study was to determine the efficacy of combination therapy with two broad-spectrum antibiotics colistin and rifampin on clinical and para clinical indexes of the patients with ventilator-dependent pneumonia due to imipenem-resistant to A. baumannii in intensive care units of a tertiary hospital. Methods: In a descriptive cross-sectional study, fifty patients admitted to the intensive care units in Vali-Asr Hospital, Arak, Iran, from October 2014 to May 2015, with established ventilator-associated pneumonia were subjected to this study and were treated with standard dosage of colistin and rifampin daily. Once the minimum inhibitory concentration (MIC) of the A. baumannii isolates were susceptible to colistin (MIC˂2 µg/ml) and rifampin (MIC˂2 µg/ml) they were treated with three million international units of colistin in 100 ml of normal saline three times a day and 600 mg of rifampin daily. Side effects of combination therapy and variables of patients like fever, blood pressure, white blood cell count, differential count and, mortality were documented and statistically analyzed. Results: 31(62%) patients were improved after combined treatment with colistin and rifampin, 4(8%) patients were died due to bloodstream infection with A. baumannii and 15(30%) passed away in effect of other reasons. The mean of BUN (P=0.07) and creatinine significantly increased (P=0.02). Clinical variables such as fever, white blood cell count, white blood cell percentage and red blood cell sedimentation rate significantly decreased (P≤0.05). Conclusion: Colistin and rifampicin appear to be an effective and safe combination therapy for treatment of ventilator-dependent pneumonia due to imipenem-resistant to A. baumannii