Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation

YANG Yilei; ZHANG Hu; CAO Jia; YI Qiaoyan; HUANG Xin; LI Yan; YANG Rui

doi:10.6039/j.issn.1001-0408.2023.19.14

您当前的位置：

首页 >

文章列表页 >

Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation

更新时间：2025-09-26

- Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation
- ZHONGGUO YAOFANG Vol. 34, Issue 19, Pages: 2385-2390(2023)
- 作者机构：
  
  1.山东第一医科大学第一附属医院（山东省千佛山医院）临床药学科，山东省儿童药物临床评价与研发工程技术研究中心，山东省医药卫生临床药学重点实验室，济南　250014
  2.山东第一医科大学第一附属医院（山东省千佛山医院）健康医疗大数据研究中心，济南　250014
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.19.14
  CLC： R969.4
- Received：06 May 2023，
  
  Revised：2023-09-12，
  
  Accepted：13 September 2023，
  
  Published：15 October 2023
- 稿件说明：
移动端阅览
杨依磊,张虎,曹佳,等.多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性[J].中国药房,2023,34(19):2385-2390.

YANG Yilei,ZHANG Hu,CAO Jia,et al.Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation[J].ZHONGGUO YAOFANG,2023,34(19):2385-2390.
杨依磊,张虎,曹佳,等.多黏菌素B雾化吸入在机械通气重症肺炎患者中的有效性和安全性[J].中国药房,2023,34(19):2385-2390. DOI： 10.6039/j.issn.1001-0408.2023.19.14.

YANG Yilei,ZHANG Hu,CAO Jia,et al.Efficacy and safety of aerosol inhalation of polycolistin B in patients with severe pneumonia combined with mechanical ventilation[J].ZHONGGUO YAOFANG,2023,34(19):2385-2390. DOI： 10.6039/j.issn.1001-0408.2023.19.14.

摘要

目的

探讨多黏菌素B雾化吸入联合静脉滴注在治疗机械通气重症肺炎患者中的有效性和安全性，为临床治疗提供真实世界参考数据。

方法

采用回顾性队列研究方法，分析2021年1月至2023年2月山东第一医科大学第一附属医院的87例机械通气重症肺炎患者的临床资料。所有患者根据给药途径不同分为联合组（24例，采用多黏菌素B雾化吸入联合静脉滴注）和常规组（63例，采用多黏菌素B单独静脉滴注），比较两组患者在有效性（死亡率、临床有效率和细菌清除率）和安全性（血肌酐升高、支气管痉挛和皮肤色素沉着）方面的差异；并采用单因素分析和多因素Logistic回归分析对主要结局指标死亡率的影响因素进行分析。

结果

在有效性方面，两组患者在死亡率（37.50% vs. 41.27%，

＝0.749）、临床有效率（54.17% vs. 55.56%，

＝0.907）和细菌清除率（45.83% vs. 44.44%，

＝0.907）方面的差异均无统计学意义。在安全性方面，联合组患者的支气管痉挛发生率显著高于常规组（12.50% vs. 0，

＝0.028），而两组间血肌酐升高和皮肤色素沉着发生率的差异均无统计学意义（

＞0.05）。单因素分析显示，感染鲍曼不动杆菌、感染肺炎克雷伯菌以及联用喹诺酮类药物的机械通气重症肺炎患者死亡率较高（

＜0.05）；多因素Logistic回归分析显示，感染鲍曼不动杆菌（OR＝3.36，

＝0.014）和联用喹诺酮类药物（OR＝3.54，

＝0.013）与死亡率独立相关（

＜0.05）。

结论

对于机械通气重症肺炎患者，多黏菌素B静脉滴注联合雾化吸入较单独静脉滴注并未显示出更加优越的有效性，反而支气管痉挛的发生率显著提高。感染鲍曼不动杆菌与联用喹诺酮类药物是该类患者死亡率提高的独立危险因素。

Abstract

OBJECTIVE

To investigate the efficacy and safety of aerosol inhalation of polycolistin B in the treatment of severe pneumonia combined with mechanical ventilation， and to provide a reference of real-world data for clinical drug therapy.

METHODS

A retrospective cohort study was conducted to analyze the clinical data of 87 patients with severe pneumonia combined with mechanical ventilation at the First Affiliated Hospital of Shandong First Medical University from January 2021 to February 2023. According to route of administration， all patients were divided into combined group （24 cases， receiving aerosol inhibition of polycolistin B combined with intravenous dripping） and routine group （63 cases， intravenous dripping of polycolistin B alone）. The differences in efficacy （mortality， clinical response rate and bacterial clearance rate）and safety（elevated serum creatinine， bronchospasm and skin pigmentation） were compared between two groups； the influential factors of primary outcome index as mortality were analyzed through univariate analysis and multivariate Logistic regression analysis.

RESULTS

In terms of efficacy， there were no statistical differences in mortality（37.50% vs. 41.27%，

＝0.749）， clinical response rate （54.17% vs. 55.56%，

＝0.907） and bacterial clearance rate （45.83% vs. 44.44%，

＝0.907） between the two groups. In terms of safety， the incidence of bronchospasm in the combined group was significantly higher than that of the routine group（12.50% vs. 0，

＝0.028）， but the differences in incidence of elevated serum creatinine and skin pigmentation between two groups were not statistically significant （

＞0.05）. Univariate analysis showed that the moralities were higher in the case of infected with

Acinetobacter baumannii

，

Klebsiella pneumoniae

and combined use of quinolones （

＜0.05）； multivariate Logistic regression analysis showed that infection with

A. baumannii

（OR＝3.36，

＝0.014） and combined use of quinolones （OR＝3.54，

＝0.013） were independently associated with mortality （

＜0.05）.

CONCLUSIONS

For severe pneumonia patients with mechanical ventilation， intravenous dripping of polycolistin B combined with aerosol inhalation does not show superior efficacy compared with intravenous dipping of polycolistin B alone， but significantly increases the incidence of bron

chospasm. Infection with

A. baumannii

and combined use of quinolones are independent risk factors for the increase of mortality.

关键词

Keywords

references

POIREL L ， JAYOL A ， NORDMANN P . Polymyxins：antibacterial activity，susceptibility testing，and resistance mechanisms encoded by plasmids or chromosomes [J ] . Clin Microbiol Rev ， 2017 ， 30 （ 2 ）： 557 - 596 .

中国医药教育协会感染疾病专业委员会，中华医学会呼吸病学分会，中华医学会重症医学分会，等 . 中国多黏菌素类抗菌药物临床合理应用多学科专家共识 [J ] . 中华结核和呼吸杂志， 2021 ， 44 （ 4 ）： 292 - 310 .

Infectious Diseases Society of China ， Chinese Thoracic Society ， Chinese Society of Critical Care Medicine ， et al . Multi-disciplinary expert consensus on the optimal clinical use of the polymyxins in China [J ] . Chin J Tuberc Respir Dis ， 2021 ， 44 （ 4 ）： 292 - 310 .

ZENG M ， XIA J ， ZONG Z Y ， et al . Guidelines for the diagnosis，treatment，prevention and control of infections caused by carbapenem-resistant gram-negative bacilli [J ] . J Microbiol Immunol Infect ， 2023 ， 56 （ 4 ）： 653 - 671 .

TAMMA P D ， AITKEN S L ， BONOMO R A ， et al . Infectious Diseases Society of America guidance on the treatment of AmpC β-lactamase-producing enterobacterales，carbapenem-resistant Acinetobacter baumannii ，and Stenotrophomonas maltophilia infections [J ] . Clin Infect Dis ， 2022 ， 74 （ 12 ）： 2089 - 2114 .

中华医学会呼吸病学分会感染学组 . 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南：2018年版 [J ] . 中华结核和呼吸杂志， 2018 ， 41 （ 4 ）： 255 - 280 .

Chinese Thoracic Society Infectiology Group . Guidelines for diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in China：2018 edition [J ] . Chin J Tuberc Respir Dis ， 2018 ， 41 （ 4 ）： 255 - 280 .

戴维·N·吉尔伯特 . 热病：桑福德抗微生物治疗指南 [M ] . 50版 . 北京：中国协和医科大学出版社， 2020 ： 124 .

GILBERT D N . The Sanford guide to antimicrobial therapy [M ] . 50th edition . Beijing ： Peking Union Medical College Press ， 2020 ： 124 .

PINTADO V ， RUIZ-GARBAJOSA P ， AGUILERA-ALONSO D ， et al . Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology （SEIMC） on the diagnosis and antimicrobial treatment of infections due to carbapenem-resistant Gram-negative bacteria [J ] . Enferm Infecc Microbiol Clin ， 2023 ， 41 （ 6 ）： 360 - 370 .

TAMMA P D ， AITKEN S L ， BONOMO R A ， et al . Infectious Diseases Society of America 2022 guidance on the treatment of extended-spectrum β-lactamase producing enterobacterales （ESBL-E），carbapenem-resistant enterobacterales （CRE），and Pseudomonas aeruginosa with diffi- cult-to-treat resistance （DTR- P. aeruginosa ） [J ] . Clin Infect Dis ， 2022 ， 75 （ 2 ）： 187 - 212 .

PAUL M ， CARRARA E ， RETAMAR P ， et al . European Society of Clinical Microbiology and Infectious Diseases （ESCMID） guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli （endorsed by European Society of Intensive Care Medicine） [J ] . Clin Microbiol Infect ， 2022 ， 28 （ 4 ）： 521 - 547 .

中华医学会呼吸病学分会 . 中国成人社区获得性肺炎诊断和治疗指南：2016年版 [J ] . 中华结核和呼吸杂志， 2016 ， 39 （ 4 ）： 253 - 279 .

Chinese Thoracic Society . Guidelines for diagnosis and treatment of adult community-acquired pneumonia in China：2016 edition [J ] . Chin J Tuberc Respir Dis ， 2016 ， 39 （ 4 ）： 253 - 279 .

《抗菌药物临床试验技术指导原则》写作组 . 抗菌药物临床试验技术指导原则附件：抗菌药物立题原则建议 [J ] . 中国临床药理学杂志， 2014 ， 30 （ 9 ）： 857 - 858 .

Writing Group of Guidance for Clinical Trials of Antibacterial Drugs . Guidance for clinical trials of anti-bacterial drugs appendix：antimicrobial reference principle suggestion [J ] . Chin J Clin Pharmacol ， 2014 ， 30 （ 9 ）： 857 - 858 .

U.S. Department of Health and Human Services . Common terminology criteria for adverse events （CTCAE） v 5 . 0 [EB/OL ] . [ 2023-07-24 ] . https：//ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_ archive https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_archive .

杜光，赵杰，卜书红，等 . 雾化吸入疗法合理用药专家共识：2019年版 [J ] . 医药导报， 2019 ， 38 （ 2 ）： 135 - 146 .

DU G ， ZHAO J ， BU S H ， et al . Expert consensus on rational drug use in aerosol inhalation therapy：2019 edition [J ] . Her Med ， 2019 ， 38 （ 2 ）： 135 - 146 .

TSUJI B T ， POGUE J M ， ZAVASCKI A P ， et al . International consensus guidelines for the optimal use of the polymyxins：endorsed by the American College of Clinical Pharmacy （ACCP），European Society of Clinical Microbiology and Infectious Diseases （ESCMID），Infectious Diseases Society of America （IDSA），International Society for Anti-infective Pharmacology （ISAP），Society of Critical Care Medicine （SCCM），and Society of Infectious Diseases Pharmacists （SIDP） [J ] . Pharmacotherapy ， 2019 ， 39 （ 1 ）： 10 - 39 .

AHMED M U ， VELKOV T ， LIN Y W ， et al . Potential to- xicity of polymyxins in human lung epithelial cells [J ] . Antimicrob Agents Chemother ， 2017 ， 61 （ 6 ）： e02690 - e02616 .

VARDAKAS K Z ， MAVROUDIS A D ， GEORGIOU M ， et al . Intravenous plus inhaled versus intravenous colistin monotherapy for lower respiratory tract infections：a systematic review and meta-analysis [J ] . J Infect ， 2018 ， 76 （ 4 ）： 321 - 327 .

ZHANG X Y ， CUI X X ， JIANG M K ， et al . Nebulized colistin as the adjunctive treatment for ventilator-associated pneumonia：a systematic review and meta-analysis [J ] . J Crit Care ， 2023 ， 77 ： 154315 .

CUI H M ， LIN X ， LIU Y Y ， et al . Comparison of different colistin regimens for the treatment of pneumonia caused by multidrug-resistant microorganisms：a systematic review and meta-analysis [J ] . Eur Rev Med Pharmacol Sci ， 2021 ， 25 （ 16 ）： 5275 - 5292 .

MATTOS K P H ， CINTRA M L ， GOUVÊA I R ， et al . Skin hyperpigmentation following intravenous polymyxin B treatment associated with melanocyte activation and inflammatory process [J ] . J Clin Pharm Ther ， 2017 ， 42 （ 5 ）： 573 - 578 .

胡付品，郭燕，吴湜，等 . CHINET中国细菌耐药监测结果： 2022 年 1 － 12 月[EB/OL ] . [ 2023-07-24 ] . http：//www.chinets.com/Document/Index?pageIndex=0 http://www.chinets.com/Document/Index?pageIndex=0 .

HU F P ， GUO Y ， WU S ， et al . CHINET surveillance results of bacterial resistance in China：January to December 2022 [EB/OL ] . [ 2023-07-24 ] . http：//www.chinets.com/Document/Index?pageIndex=0 http://www.chinets.com/Document/Index?pageIndex=0 .

Views

272

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Network meta-analysis of first-line treatment of metastatic colorectal cancer with different chemotherapy combination regimens

Efficacy and safety of luspatercept in the treatment of myelodysplastic syndrome anemia：a single-group rate meta-analysis

Improve effects of aromatase inhibitors on the height of children with short stature

Efficacy and safety of Compound danshen preparations combined with chemical drugs for peptic ulcer： a meta-analysis

Efficacy and safety of different treatments for moderate to severe Henoch-Schönlein purpura nephritis： a network meta-analysis

Related Author

ZHANG Xiaoqing

LIU Shuai

ZHANG Kai

JI Beibei

LUAN Wei

LI Jiajing

WANG An’an

GUO Yuancheng

Related Institution

Inner Mongolia Clinical Medical College， Inner Mongolia Medical University

Day-care Unit， Inner Mongolia Armed Police Hospital

Dept. of Medical Oncology， Inner Mongolia People’s Hospital

The First Clinical Medical College， Lanzhou University

Dept. of Hematology， the First Hospital of Lanzhou University

Address：8th Floor, Sihuan Building, No. 129 Daping Main Street, Yuzhong District, Chongqing, China Postal code：400042
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰