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作 者:陈红伟[1] 娄元华 李小勇[1] 潘栋超[1] 解东成 刘东升[1]
出 处:《中国感染控制杂志》2016年第6期384-387,392,共5页Chinese Journal of Infection Control
摘 要:目的:探讨替加环素联合头孢哌酮/舒巴坦治疗耐药鲍曼不动杆菌(DRAB)颅内感染的临床疗效及安全性。方法回顾性分析2014年1月—2015年4月某院脑脊液病神经外科收治的12例 DRAB 颅内感染患者,评价替加环素联合头孢哌酮/舒巴坦治疗 DRAB 颅内感染患者的临床疗效及安全性。结果替加环素联合头孢哌酮/舒巴坦抗感染治疗12~62 d(平均39.5 d),大多数患者临床症状、体征(包括体温、脑膜刺激征)等较治疗前均有明显改善,其中痊愈3例,显效5例,放弃或无效(死亡)4例。临床总有效率为66.67%(8/12),病死率33.33%(4/12),脑脊液细菌清除率为83.33%(10/12)。死亡原因:2例因脑外伤后脑干衰竭,1例因脑实质广泛感染,1例因治疗有效后停药致颅内感染复发、脑脓肿形成。治疗期间未发生明显不良反应。结论在保持脑脊液引流通畅的前提下,替加环素联合头孢哌酮/舒巴坦长程治疗能有效清除脑脊液 DRAB,且具有良好的安全性。Objective To evaluate clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug-resistant Acinetobacter baumannii (DRAB).Methods 12 patients with DRAB intracranial infection admitted in a department of neurosurgery between January 2014 and April 2015 were analyzed retrospectively,clinic efficacy and safety of tigecycline combined with cefoperazone/sulbactam for treatment of DRAB intracranial infection were evaluated.Results After patients received tigecycline combined with cefoperazone/sulbactam for 12-62 days (39.5 days on average), clinical symptoms and signs (including body temperature,signs of meningeal irritation)of most patients were significantly improved compared with before treat-ment,3 cases were cured,5 were markedly effective,4 abandoned or ineffective(death).The overall effective rate was 66.67%(8/12),mortality was 33.33% (4/12);bacterial clearance rate of cerebrospinal fluid (CSF)was 83.33%(10/12).Causes of death:2 were with failure of brain stem following craniocerebral trauma,1was extensive parenchymal infection,1was recurrence of intracranial infection and formation of brain abscess after withdrawing an-timicrobial agents.No significant adverse reaction occurred during the treatment period.Conclusion On the basis of keeping CSF drainage unobstructed,long course treatment of tigecycline combined with cefoperazone/sulbactam can effectively eliminate DRAB from CSF,and has a good safety.
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