替加环素治疗血液系统恶性肿瘤并发感染的疗效及其影响因素  

Efficacy and influencing factors of tigecycline in the treatment of hematological malignancies complicated with infection

作　　者：方会慧[1,2] 许元宝[1,2] 孙旭群[1,2] 汪燕燕[1,2] 方先骏 夏瑞祥[3] 夏泉[1,2] FANG Hui-hui;XU Yuan-bao;SUN Xu-qun;WANG Yan-yan;FANG Xian-jun;XIA Rui-xiang;XIA Quan(Department of Pharmacy,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Third-grade Pharmaceutical Chemistry Laboratory of State Administration of Traditional Chinese Medicine,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Hematology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院药剂科,安徽合肥230022 [2]安徽医科大学第一附属医院国家中医药管理局中药化学三级实验室,安徽合肥230022 [3]安徽医科大学第一附属医院血液内科,安徽合肥230022

出　　处：《中国感染控制杂志》2021年第6期505-511,共7页Chinese Journal of Infection Control

基　　金：安徽省省级临床重点专科建设项目(卫科教秘〔2017〕529号);安徽省高等学校省级质量工程项目(2017jyxm1074)。

摘　　要：目的探讨替加环素治疗血液系统恶性肿瘤并发感染的疗效及其影响因素,为临床合理用药提供参考。方法回顾性分析某院血液系统恶性肿瘤并发感染且应用替加环素患者的临床资料,评价替加环素治疗的临床疗效,利用单因素分析和多因素logistic回归分析影响患者疗效的因素。结果共纳入182例患者,85例(46.7%)患者原发疾病为急性髓系白血病,粒细胞缺乏者116例(63.7%),感染部位主要为肺部(72.0%)。分离病原菌62株,其中8株为耐碳青霉烯类肠杆菌目细菌。113例(62.1%)患者使用高剂量替加环素,疗程为(11.6±6.5)d,临床总有效率为55.5%。多因素分析结果显示,社区获得性肺炎、粒细胞缺乏时间>14 d和替加环素疗程<7 d是治疗失败的独立危险因素,治疗效果与患者性别、年龄、原发疾病、替加环素剂量、联合用药及感染病原菌无关。结论替加环素对血液恶性肿瘤并发感染患者有较好的疗效,但社区获得性肺炎、粒细胞缺乏时间>14 d和替加环素疗程<7 d会明显影响其疗效。Objective To investigate the efficacy and influencing factors of tigecycline in the treatment of hematological malignancies complicated with infection,so as to provide reference for clinical rational antimicrobial use.Methods Clinical data of patients with hematological malignancies complicated with infection and treated with tigecycline in a hospital were analyzed retrospectively,clinical efficacy of tigecycline treatment was evaluated,influencing factors of therapeutic efficacy of patients was analyzed by univariate analysis and multivariate logistic regression analysis.Results A total of 182 patients were included in analysis,85(46.7%)patients had acute myeloid leukemia,116(63.7%)had agranulocytosis,the main infection site was lung(72.0%).62 strains of pathogens were isolated,8 of which were carbapenem-resistant Enterobacterales.113 patients(62.1%)were treated with high-dose tigecycline for a course of(11.6±6.5)days,the total effective rate was 55.5%.Multivariate analysis showed that community-acquired pneumonia,agranulocytosis time>14 days and tigecycline treatment course<7 days were independent risk factors for treatment failure,therapeutic efficacy was not related to gender,age,primary disease,tigecycline dose,combination antimicrobial use and pathogenic bacteria.Conclusion Tigecycline is effective for the treatment of patients with hematological malignancies complicated with infection,but community-acquired pneumonia,agranulocytosis time>14 days and tigecycline treatment course<7 days will significantly affect the efficacy.

关 键 词：替加环素 血液系统 恶性肿瘤 感染 疗效 影响因素 

分 类 号：R181.3+2[医药卫生—流行病学] R515[医药卫生—公共卫生与预防医学]