替加环素治疗泛耐药鲍曼不动杆菌医院获得性肺炎的临床疗效及不良反应  

Clinical efficacy and adverse reactions of tigecycline in treatment of healthcareassociated pneumonia caused by extensively drug-resistant Acinetobacter baumannii

作　　者：王凯歌[1] 谭芬[1] 彭红[1] 陈平[1] 

机构地区：[1]中南大学湘雅二医院湖南省呼吸疾病诊疗中心中南大学呼吸疾病研究所,湖南长沙410011

出　　处：《中国感染控制杂志》2016年第2期97-101,共5页Chinese Journal of Infection Control

基　　金：国家自然科学基金(81370164);湖南省自然科学基金(2015JJ4087);国家临床重点专科建设项目

摘　　要：目的观察替加环素对泛耐药鲍曼不动杆菌(XDRAB)医院获得性肺炎(HAP)的临床疗效及不良反应。方法对2013年3月—2014年6月某院重症监护病房(ICU)发生XDRAB HAP并使用替加环素治疗的患者临床资料进行回顾性分析。结果 31例HAP患者痰分离的XDRAB对替加环素均敏感,对碳青霉烯类及舒巴坦类抗生素,包括头孢哌酮/舒巴坦(SCF),耐药率为100%,其中混合感染患者17例(54.84%)。替加环素联用SCF使用率:呼吸ICU组为85.71%(12/14),中心ICU组为47.06%(8/17)。31例患者,临床痊愈率为29.03%、有效率为45.16%,细菌清除率为61.29%,药物不良反应率为16.13%,无严重药物不良反应发生。呼吸ICU组与中心ICU组痊愈率分别为42.86%、17.65%,有效率分别为71.43%、23.53%,细菌清除率分别为78.57%、47.06%,两组临床有效率比较,差异具有统计学意义(P<0.05)。替加环素联用SCF组与非联用SCF组痊愈率分别为35.00%、18.18%,有效率为60.00%、18.18%,细菌清除率为65.00%、54.55%,两组临床有效率比较,差异具有统计学意义(P<0.05)。结论替加环素对XDRAB HAP具有良好的临床疗效,药物不良反应少;联合SCF是一个值得推广的选择。Objective To observe the clinical efficacy and adverse reactions of tigecycline in treatment of healthcare-associated pneumonia（HAP）caused by extensively drug-resistant Acinetobacter baumannii（XDRAB）.Methods Clinical data of patients who used tigecycline for the treatment of XDRAB HAP in intensive care units of a hospital from March 2013 to June 2014 were retrospectively analyzed.Results XDRAB isolated from31 patients with HAP were all sensitive to tigecycline,the resistance rates to carbapenems and sulbactams（including cefoperazone-sulbactam,SCF）were all 100%,17 cases（54.84%）were mixed infection.Combined use rates of tigecycline and SCF were 85.71%（12/14）in respiratory intensive care unit（RICU）and 47.06%（8/17）in general intensive care unit（GICU）.Of 31 patients,the cure rate,effective rate,bacterial clearance rate,and antimicrobial adverse reaction rate were 29.03%,45.16%,61.29%,and 16.13% respectively,no serious adverse drug reactions occurred.In RICU group and GICU group,the cure rates were 42.86% and 17.65% respectively,effective rates were71.43% and 23.53% respectively,and bacterial clearance rates were 78.57% and 47.06%respectively,difference in effective rate between two groups was significant（P〈0.05）.Among patients receiving combination of tigecycline and SCF as well as not receiving combined SCF,the cure rates were 35.00% and 18.18% respectively,effective rates were 60.00% and 18.18%respectively,and bacterial clearance rates were 65.00% and 54.55%respectively,difference in effective rate between two groups was significant（P〈0.05）.Conclusion Tigecycline has a good clinical efficacy and little adverse reaction in treating XDRAB HAP;tigecycline combined with SCF is a good choice.

关 键 词：替加环素 泛耐药鲍曼不动杆菌 医院获得性肺炎 头孢哌酮/舒巴坦 

分 类 号：R181.32[医药卫生—流行病学]