头孢他啶阿维巴坦与多黏菌素B对广泛耐药肺炎克雷伯杆菌感染的疗效及预后比较  

Efficacy and Prognosis of Ceftazidime-avibactam Versus Polymyxin B in the Treatment of Infections Due to Extensively Drug-resistant Klebsiella pneumoniae

作　　者：郭晓芳[1] 梁培[2] 尤勇[1] 朱章华[1] GUO Xiaofang;LIANG Pei;YOU Yong;ZHU Zhanghua(Department of Intensive Care Unit;Department of Pharmacy,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,南京210008 [2]南京大学医学院附属鼓楼医院药学部,南京210008

出　　处：《药学与临床研究》2020年第6期447-450,共4页Pharmaceutical and Clinical Research

摘　　要：目的:比较头孢他啶阿维巴坦(ceftazidime-avibactam,CAZ-AVI)与多黏菌素B对广泛耐药肺炎克雷伯杆菌(XDR-KP)感染的疗效及预后分析。方法:回顾性分析我院ICU收治的XDR-KP感染患者,分为CAZ-AVI组和多黏菌素B组,比较两组性别、年龄、合并症、APACHEⅡ评分、感染类型、细菌对药物耐药性等基础指标,并记录培养至抗XDR-KP治疗间隔时间、疗程、是否联合治疗、联合治疗药物、细菌清除率、是否临床治愈、住院时间、30天死亡率、住院费用及不良反应等资料。结果:共纳入51例XDR-KP患者,其中CAZ-AVI组16例,多黏菌素B组35例,两组之间培养至抗XDR-KP治疗间隔时间、疗程、联合治疗药物、临床治愈率、住院时间、住院费用及30天死亡率差异均无统计学意义(P均>0.05);然而CAZ-AVI组细菌清除率高于多黏菌素B组(68.75%vs.37.14%,P<0.05),联合治疗比例(68.75%vs.94.28%,P<0.05)及不良反应皮肤色素沉着发生率低于多黏菌素B组(0.00%vs.48.57%,P<0.05)。结论:CAZ-AVI及多黏菌素B对于抗XDR-KP感染治疗均具有良好效果。与多黏菌素B相比,CAZ-AVI细菌清除率高,药物不良反应少,然而在临床治愈及预后方面并没有显示出效价优势。Objective:This article compared the efficacy and prognosis of ceftazidime-avibatam(CAZ-AVI)and polymyxin B in the treatment of infections due to extensive drug-resistant Klebaiella pneumoniae(XDR-KP).Methods:Retrospectively analyzing the XDR-KP infected patients admitted to the ICU,the patients were divided into CAZ-AVI group and polymyxin B group.The gender,age,comorbidity,APACHEⅡscore,infection type,bacterial drug sensitivity,the time from culture to anti-XDR-KP,the course of treatment,combined therapy,combined drugs,bacterial clearance rate,whether it was clinically cured,hospitalized time,mortality,hospital costs and adverse reactions were compared between the two groups.Results:Among the 51 patients with XDR-KP infection,16 cases in the CAZ-AVI group and 35 cases in the polymyxin B group were identified.There was no difference in the time from culture to anti-XDR-KP,the course of treatment,combined drugs,clinically cured rate,hospitalized time,mortality or hospital costs(all P>0.05).Compared with the polymyxin B group,the CAZ-AVI group showed lower proportion of combined treatment(68.75%vs.94.28%,P<0.05),higher bacterial clearance rate(68.75%vs.37.14%,P<0.05)and lower incidence of skin pigmentation(0.00%vs.48.57%,P<0.05).Conclusion:CAZ-AVI and polymyxin B have good results in anti-XDR-KP infection treatment.Compared with polymyxin B,CAZ-AVI improves bacterial clearance and has fewer adverse drug reactions while shows no advantage in clinical cure and prognosis.

关 键 词：广泛耐药肺炎克雷伯杆菌 头孢他啶阿维巴坦 多黏菌素B 疗效 预后 

分 类 号：R969.4[医药卫生—药理学]