Abstract: Objective:In recent years, multidrug-resistant Acinetobacter baumannii (MDRAB) has become a great threat to human health. Since the therapeutic drugs for MDRAB infection are limited, a loading dose polymyxin B treatment regimen has been proposed. The aim of this study was to investigate the efficacy and safety of the loading dose polymyxin B combination regimen for the treatment of MDRAB infection, as well as to analyze the clinical characteristics and risk factors for death in patients with MDRAB infection. METHODS:Clinical collection plus retrospective investigation of patients who developed MDRAB and used polymyxin B from January 1, 2019 to April 17, 2021 in the First Affiliated Hospital of Nanchang University. The patients were divided into loading dose polymyxin B group (LD group) and non-loading dose polymyxin B group (non-LD group) according to whether the treatment regimen used loading dose polymyxin B treatment or not, and compared the drug resistance, admission department, infection type, gender, age, comorbidities, clinical characteristics, therapeutic efficacy, adverse reactions, and prognosis of patients in the two groups and analyzed the risk of death by comparing the survival group with the death group. The risk factors of death were analyzed by comparing the survival group with the death group. Results: (1) Among the sensitivities of MDRAB to the 16 antibiotics commonly used in the clinic, the top three drugs in the MIC range were cotrimoxazole (MIC=2-320 mg/L), piperacillin-tazobactam (MIC=64/4-128 mg/L), ceftriaxone (MIC=1-64 mg/L), and the lowest resistance rate was 0% in the case of peptides (polymyxin B). The lowest resistance rate was 0%, followed by 3.3% to tetracyclines (tigecycline), and all other antimicrobials had resistance rates >75%. (2) A total of 159 patients with MDRAB infection were included in this study, including 110 patients in the LD group and 49 patients in the non-LD group, and the top five departments with microbial culture for MDRAB were intensive care medicine (33.3%), respiratory and critical care medicine (22.0%), neurology (13.2%), emergency medicine (10.1%), and neurosurgery (6.9%). The sources of infection were pulmonary (89.3%), intracranial (2.5%), central venous catheter (1.9%), blood (1.9%), and pus (1.9%). The mortality rates were bloodstream infection (66.6%), urinary tract infection (50%), lung infection (33.8%), central venous catheter infection (33.3%), and pus infection (33.3%). (3) There were no statistical differences between the LD and non-LD groups in demographic characteristics, comorbidities, and clinical characteristics (P>0.05). There was no statistically significant difference between the two groups in terms of total efficacy rate (P>0.05), but the recovery rate of 18.2% in the LD group was significantly higher than that of 6.1% in the non-LD group and was statistically different (P<0.05). There was no statistically significant difference between the two groups in the safety analysis results (P>0.05). (4)The overall hospitalization mortality rate of MDRAB-infected patients was 33.9%, and the hospitalization mortality rates of patients in the LD group and non-LD group were 28.2% and 46.9%, respectively, which were statistically different (P<0.05). (5) Kaplan-Meier survival analysis found that the cumulative survival time of patients in the LD group was significantly longer than that in the non-LD group (mean: 78 vs 3...
Zhu Conglei. Efficacy and safety analysis of loading dose polymyxin B in the treatment of MDRAB infection [D]. Supervisor: Wu Zhengping;Ouyang Aijun. Yichun College, 2022.