以多黏菌素B为基础联合治疗ICU泛耐药革兰阴性菌感染脓毒症的临床分析  

Clinical analysis of sepsis with extensively drug resistant Gram-negative bacteria in intensive care unit treated with polymyxin B-based combination therapy

作　　者：赵双平[1] 闫莉婷 王池香 彭米林 Zhao Shuangping;Yan Liting;Wang Chixiang;Peng Milin(Department of Critical Care,Xiangya Hospital,Central South University,Changsha 410008,Hunan,China;Department of Critical Care,Shizuishan Second People's Hospital,Shizuishan 753000,Ningxia Hui Autonomous Region,China)

机构地区：[1]中南大学湘雅医院重症医学科,湖南长沙410008 [2]石嘴山市第二人民医院重症医学科,宁夏回族自治区石嘴山753000

出　　处：《中华危重病急救医学》2020年第2期150-154,共5页Chinese Critical Care Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金项目(320.6750.18425)。

摘　　要：目的:探讨多黏菌素B对泛耐药(XDR)革兰阴性菌重症感染患者的临床疗效及安全性。方法:回顾性分析2018年6月至2019年9月中南大学湘雅医院重症医学科收治的39例以多黏菌素B为基础联合抗感染治疗XDR革兰阴性菌感染脓毒症患者的临床资料。收集患者临床特征、细菌培养及药敏试验结果、抗菌药物种类及疗程、生化指标、多黏菌素B用药前后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),评估患者细菌清除率、临床疗效、用药不良反应、28 d病死率等。结果:39例患者中男性32例,占82.1%;年龄(53.6±12.6)岁;以肺部感染为主(51.2%);均为多黏菌素B联合用药,多黏菌素B疗程均≥5 d。39例患者共检出66株XDR病原菌,其中鲍曼不动杆菌检出率最高,为51.5%(34/66);菌株清除率为65.2%(43/66)。39例患者经多黏菌素B治疗后,整体治疗有效率为59.0%(23/39),28 d全因病死率为41.0%(16/39)。多黏菌素B不同疗程组间患者治疗有效率及细菌清除率差异均无统计学意义〔<10 d、10~15 d、>15 d组治疗有效率分别为56.5%(13/23)、54.5%(6/11)、80.0%(4/5),χ2=0.999,P=0.728;细菌清除率分别为43.5%(10/23)、54.5%(6/11)、80.0%(4/5),χ2=2.141,P=0.393〕。多黏菌素B日剂量150 mg组和200 mg组治疗有效率及细菌清除率均明显高于日剂量100 mg组〔治疗有效率:85.7%(6/7)、87.5%(7/8)比41.7%(10/24);细菌清除率:71.4%(5/7)、87.5%(7/8)比33.3%(8/24),均P<0.05〕,但不同日剂量组间重症监护病房(ICU)住院时间和机械通气时间差异均无统计学意义。多黏菌素B用药后APACHEⅡ评分(分)明显低于用药前(所有患者:16.20±9.24比24.40±4.73,治疗有效患者:11.30±4.08比23.00±4.56,均P<0.05)。有4例肾功能不全患者在使用多黏菌素B期间出现血肌酐升高,停药后恢复,未发生其他不良反应。结论:多黏菌素B可以作为XDR革兰阴性菌重症感染患者的有效治疗选择。Objective To investigate the clinical efficacy and safety of polymyxin B in the treatment of sepsis caused by extensively-drug resistant(XDR)Gram-negative bacteria.Methods A retrospective analysis of 39 septic patients with XDR Gram-negative bacterial infection treated with polymyxin B in the department of critical care medicine of Xiangya Hospital of Central South University from June 2018 to September 2019 were enrolled.The clinical characteristics,bacterial culture,the sensitivity antibacterial drugs,types and courses of antibiotics,biochemical indexes,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)before and after polymyxin B treatment were collected,to assess microbial clearance and efficacy,drug related adverse effects,and 28-day mortality in septic patients with XDR.Results Of the 39 septic patients with XDR,32(82.1%)were male,with the mean age of(53.6±12.6)years old.The main infection site was pulmonary infection(51.2%),and the treatment courses of polymyxin B were≥5 days.A total of 66 pathogenic bacteria were detected from 39 patients.Among them,with the high estrate of detecting Acinetobacter baumannii of 51.5%(34/66).After treatment with polymyxin B,the results showed that the clearance rate of microorganisms was 65.2%(43/66),the overall effective rate was 59.0%(23/39),and the 28-day all-cause mortality was 41.0%(16/39).There were no significant differences in clinical efficacy and microbial clearance among patients with different treatment groups of polymyxin B[<10 days,10-15 days,and>15 days groups:effective rates were 56.5%(13/23),54.5%(6/11),80.0%(4/5),χ^2=0.999,P=0.728;the microbial clearance rates were 43.5%(10/23),54.5%(6/11),and 80.0%(4/5),χ^2=2.141,P=0.393].The effective and microbial clearance rates of the polymyxin B daily doses of 150 mg and 200 mg groups were significantly higher than those of the daily dose of 100 mg[effectiveness:85.7%(6/7),87.5%(7/8)vs.41.7%(10/24);microbial clearance rate:71.4%(5/7),87.5%(7/8)vs.33.3%(8/24),all P<0.05],however,there were no signif

关 键 词：多黏菌素B 泛耐药 革兰阴性菌 脓毒症 

分 类 号：R459.7[医药卫生—急诊医学]