替加环素治疗血液病患者继发感染的疗效分析  

Efficacy of tigecycline in treating severe infections of patients with hematological diseases

作　　者：吴玉红[1] 胡志东[1] 邢莉民[1] 王化泉[1] 刘鸿[1] 关晶[1] 付蓉[1] 李丽娟[1] 王国锦[1] 宋嘉[1] 瞿文[1] 王晓明[1] 邵青[1] 于红[1] 王一浩[1] 李丽燕[1] 高珊[1] 邵宗鸿[1] 

机构地区：[1]天津医科大学总医院血液科,300052

出　　处：《中华医学杂志》2014年第34期2669-2672,共4页National Medical Journal of China

摘　　要：目的评价替加环素治疗血液病继发感染的疗效及安全性。方法将85例血液病继发感染的住院患者分为经验和目标治疗两组。对无微生物学依据，经抗感染治疗3～5d疗效不佳，更换替加环素治疗者，为经验治疗组；一旦获得微生物学证据，及时更换替加环素治疗者为目标治疗组。替加环素的用法：首剂100mg，维持50mg，1次／12h，疗程2—4周。结果85例患者，除11例发生血流感染，2例发热原因不明外，最常见的感染部位为下呼吸道。共分离出45株菌株，以嗜麦芽窄食单胞菌为主（占40％），产超广谱B一内酰胺酶（ESBLS）＋的多药耐药革兰氏阴性杆菌占15．6％。球菌5株，其中耐甲氧西林金黄色葡萄球菌（MRSA）＋的金黄色葡萄球菌3株，屎肠球菌2株。替加环素治疗的临床有效率为72．9％，对鲍曼不动杆菌、产ESBLS＋的革兰氏阴性杆菌、嗜麦芽窄食单胞菌清除率分别为85％、70％、55％。经验治疗组与目标治疗组疗效相当。替加环素治疗肺部感染、继发血流感染有效率分别为71％及45．5％，中性粒细胞绝对值〈0．2×10^9／L者，有效率明显降低（45％与81．5％，P=0．003）。不良反应轻，主要为消化道不适症状。结论替加环素可作为血液病患者继发多药耐药菌感染一个新的治疗选择。对常规抗感染疗效不佳者，替加环素的经验治疗可提高疗效。Objective To evaluate the efficacy and safety of tigecycline in treating secondary infections of patients with hematological diseases. Methods A total of 85 cases of hematological patients with secondary infections were classified into empirical and targeted therapy groups. Empirical therapy group was composed of patients receiving tigecycline as an alternative due to ineffective anti-infection treatment for 3 - 5 days in the absence of microbiological evidence while those taking tigecycline based on microbiological evidence belonged to targeted therapy group. Dosage regimen of tigecycline： loading dose 100 mg, 50 mg every 12 hours as maintenance therapy for 2 -4 weeks. Results Among them, except for 11 cases of bloodstream infections and 2 cases of fever for unknown reasons, the most common site for infection was lower respiratory tract. Among 45 isolated bacterial strains, Stenotrophomonas maltophilia （40%） was the most commonly seen while extended spectrum beta-lactamases （ESBLS） ＋ muhidrng resistant gram negative bacilli 15.6%. Among 5 bacterial strains, there were 3 methicillin-resistant Staphylococcus aureus ＋ golden staphylococci strains and 2 excrement enteroeocci. The total effective rate of tigecycline was 72. 9%. And the bacterial clearance rates of acinetobacter baumannii, ESBLS ＋ gram-negative bacillus and stenotrophomonas mahophilia were 85%, 70% and 55% respectively. The effect of tigecycline was equivalent for two groups. Pneumonia patients obtained an effective rate of 71%, compared to those with bloodstream infections （54. 5% ）. For patients whose absolute neutrophil counts were less than 0. 2 × 10^9/L, the effective rate decreased obviously （45% vs 81.5%, P =0. 003）. Adverse reaction was mild due to mostly gastrointestinal symptoms. Conclusion Tigeeycline is a new treatment choice in treating secondary multidrng resistant infections of patients with hematological diseases. Empirical therapy of tigecycline may improve the therapeutic efficacy of patients non-responding f

关 键 词：替加环素 血液病 感染 

分 类 号：R552[医药卫生—血液循环系统疾病]