Efficacy of eravacycline on pulmonary infection caused by carbapenem-resistant Acinetobacter baumannii
Objective To investigate the efficacy and safety of eravacycline in the treatment of carbapenem-resistant Acinetobacter baumannii(CRAB)pulmonary infection.Methods Sixty patients with CRAB pulmonary infection were diagnosed and treated in Henan Provincial People's Hospital from November 2023 to March 2024,among whom 30 patients received intravenous drip of eravacycline 1 mg/kg once per 12 h(observation group),and the other 30 patients received intravenous drip of polymyxin B 500 000 u once per 12 h with first dose doubled(control group).Besides the above treatment,both two groups were given intravenous drip of cefoperazone-sulbactam(3.0 g once per 8 h),and mechanical ventilation and nutritional support according to patients'conditions.After 5-d treatment,the total effective rate was observed in two groups,and the Murray Lung Injury Score,Sequential Organ Failure Assessment(SOFA)score,Acute Physiology and Chronic Health Assessment Ⅱ(APACHE Ⅱ)score,inflammatory indexes(white blood cell count,C-reactive protein,procalcitonin),cytokines[interleukin(IL)-4,IL-6,IL-10],and peripheral blood T lymphocyte subsets were compared before and after treatment.The occurrence of adverse reactions during treatment was observed in two groups,and the mechanical ventilation time,length of ICU stay,and fatality rate were recorded.Results After 5-d treatment,the total effective rate was higher in observation group(90.0％)than that in control group(66.7％)(x2=4.812,P=0.028).The Murray Lung Injury Score,APACHE Ⅱ score,SOFA score,white blood cell count,C-reactive protein,procalcitonin,IL-4,IL-6 and IL-10 were lower after treatment in observation group[1.50(1.00,4.25),5.50(3.00,14.25),3.50(2.00,5.00),4.66 × 109/L(4.23 × 109/L,8.05 × 109/L),24.50(14.62,68.14)mg/L,0.24(0.13,0.61)μg/L,0.69(0.23,3.98)ng/L,24.11(18.62,78.05)ng/L,1.53(0.98,6.55)ng/L]than those in control group[3.00(3.00,6.00),9.40(4.50,11.50),5.50(2.50,7.25),8.27× 109/L(6.88×109/L,10.38×109/L),45.67(23.78,87.78)mg/L,0.53(0.09,0.99)μg/L,1.29(0.44,3.25)ng/L,55.33(22.87,100.77)ng/L,4.55(1.23,10.11)ng/L](Z=-0.765 to-0.245,all P values＜0.05),and were lower after treatment than those before treatment in two groups(Z=-4.490 to-1.675,all P values＜0.05).No significant differences were found in the levels of CD4+T lymphocytes,CD8+T lymphocytes,and total T lymphocytes after treatment between observation group[580(245,890),306(113,676),788(321,1 455)cells/μL]and control group[536(156,754),296(142,723),821(356,1 577)cells/μL](Z=-2.121,-1.887,-1.786;all P values＞0.05),and all the above indicators were higher after treatment than those before treatment in two groups(Z=-3.707 to-2.998,all P values＜0.05),and showed no significant differences between two groups before treatment(Z=-1.898 to-0.022,all P values＞0.05).The mechanical ventilation time and duration of ICU stay were shorter in observation group[(9.43±3.16),(12.93±4.73)d]than those in control group[(14.54±4.13),(17.88±5.12)d](t=-6.488,P＜0.001;t=-8.663,P＜0.001),the fatality rate was lower in observation group(20.0％)than that in control group(46.7％)(x2=4.800,P=0.028),and the incidence of adverse reactions showed no significant difference between observation group(10.0％)and control group(13.3％)(x2=0.162,P=0.688).Conclusions Eravacycline/polymyxin B combined with cefoperazone-sulbactam is safe and effective for CRAB pulmonary infection.Compared with polymyxin B,eravacycline has a better therapeutic effect,can reduce inflammatory reactions,shorten mechanical ventilation time and length of ICU stay,and reduce the fatality rate.
pulmonary infectioncarbapenem-resistant Acinetobacter baumanniieravacyclinepolymyxin B
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