替加环素联合头孢哌酮/舒巴坦治疗耐药鲍曼不动杆菌颅内感染临床研究  

Clinical study of tigecycline combined with cefoperazone/sulbactam for treatment of intracranial infection with drug-resistant Acinetobacter baumannii

作　　者：陈红伟[1] 娄元华 李小勇[1] 潘栋超[1] 解东成 刘东升[1] 

机构地区：[1]中国医科大学航空总医院,北京100012

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.

关 键 词：替加环素 鲍曼不动杆菌 头孢哌酮/舒巴坦 颅内感染 脑脊液 

分 类 号：R181.32[医药卫生—流行病学]