产超广谱β-内酰胺酶肠杆菌科细菌血流感染的经验性治疗分析  

Empirical therapy of bloodstream infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae

作　　者：汤陈琪[1] 李骏强 夏照帆[1] 王慧[2] 吕开阳[1] 肖仕初[1] 邓安梅[2] 黄怡[3] 

机构地区：[1]第二军医大学附属长海医院烧伤科,上海200433 [2]第二军医大学附属长海医院检验科,上海200433 [3]第二军医大学附属长海医院感控科,上海200433

出　　处：《中华医学杂志》2016年第26期2076-2080,共5页National Medical Journal of China

基　　金：中国工程院咨询研究项目（2015-XY-26）

摘　　要：目的 分析产超广谱β-内酰胺酶（ESBL）肠杆菌科细菌血流感染患者经验性使用碳青霉烯类药物和酶抑制剂合剂治疗的临床结果。方法 回顾性分析2013年1月至2015年6月长海医院收治的产ESBL肺炎克雷伯菌和大肠埃希菌血流感染患者的临床资料。根据经验性治疗方案分为碳青霉烯类药物组和酶抑制剂合剂组。采用倾向性得分匹配法以1∶1对两组患者进行最近邻匹配。匹配前后分别比较两组的病死率、住院时间和医疗费用。结果共纳入了158例患者，碳青霉烯类药物组93例，酶抑制剂合剂组65例。匹配前，两组患者的科室分布、罹患肿瘤率、深静脉置管率、尿管、胃管、呼吸机使用率等差异均有统计学意义（均P〈0.05），而且碳青霉烯类药物组感染后住院时间和总住院时间均显著长于酶抑制剂合剂组（12.0比10.0 d，P＝0.044和26.0比18.0 d，P＝0.029），住院总费用和日均住院费用也更高（84 120比39 000元，P〈0.001和3 451比2 574元，P＝0.002）。匹配后得到50对患者，各协变量如年龄、性别、科室分布、感染病原体、入院评分、主要合并症、侵入性治疗、感染前住院时间、多次入院史、在院期间手术史、抗菌治疗延迟在两组间分布均衡（均P〉0.05）。两组患者的在院病死率、感染后住院时长、总住院时长、住院费用以及抗菌药物费用差异均无统计学意义（均P〉0.05）。结论酶抑制剂合剂是碳青霉烯类药物较为理想的替代选择，能够在产ESBL肠杆菌科细菌血流感染的经验性治疗中发挥重要作用。Objective To compare the clinical outcomes and costs associated with carbapenems and β-lactam/β-lactamase inhibitor combinations （BLBLIs） for the empirical treatment of patients with extended-spectrum β-laetamase （ESBL）-positive Enterobacteriaceae bloodstream infections （BSIs）. Methods The medical records of individuals diagnosed with ESBL-produeing Escherichia coli and Klebsiella pneumoniae BSIs between January 2014 and June 2015 at Changhai Hospital were reviewed. Patients were divided into two groups based on the empirical therapy （carbapenems group and BLBLIs group）. Propensity score matching in a l： 1 ratio was used to match the patients from two groups. Clinical outcomes and costs were compared before and after matching. Results One hundred and fifty-eight patients were analyzed, 93 in the carbapenems group and 65 in the BLBLIs group. Before matching, the two groups were significantly different in department distribution, tumor rate, deep vein catheter rate, urinary catheter rate, nasogastric tube rate, and mechanical ventilation rate （ all P 〈 0. 05 ）, and the carbapenems group had longer total length of stay （LOS） and post-BSI LOS （26.0 vs 18.0 d, P=0.029 and 12.0 vs 10.0 d, P=0.044） , higher hospital cost and daily hospital cost （84 120 vs 39 000￥, P〈0.001 and 3 451 vs 2 574 ￥, P =0.002）. After matching, the two groups had no significant differences in eovariates such as sex, age, department distribution, pathogens, comorbidities, invasive interventions, LOS before BSI, multiple admissions, surgical rate during hospitalization and delayed antimicrobial therapy （ all P 〉 0.05 ）. Finally, there were no differences between two groups in mortality, post-BSI LOS, total LOS, hospital cost and antimicrobial cost all P 〉 0. 05）. Conclusion BLBLIs may provide a reasonable carbapenem-sparing option for the empirical treatment of ESBL producers.

关 键 词：Β内酰胺酶类 克雷伯菌 肺炎 大肠埃希菌 血流感染 治疗结果 

分 类 号：R446.5[医药卫生—诊断学]