大环内酯类抗菌药物联合解热止嗽汤治疗携带bla_(KPC-2)基因病原菌感染肺炎的疗效  

Effect of macrolides antibiotics combined with Jierezhisou Decoction on treatment of pneumonia caused by pathogens carrying with bla_(KPC-2) gene

作　　者：尹伟栋 钱根才 童江民 沈月英 高春新 YIN Wei-dong;QIAN Gen-cai;TONG Jiang-min;SHEN Yue-ying;GAO Chun-xin(Changxing District,Children's Hospital Affiliated to Zhejiang University,Huzhou,Zhejiang 313100,China)

机构地区：[1]浙江大学附属儿童医院长兴院区儿内科,浙江湖州313100

出　　处：《中华医院感染学杂志》2021年第10期1456-1459,共4页Chinese Journal of Nosocomiology

基　　金：浙江省科技厅自然科学基金资助项目(LY21H050037)。

摘　　要：目的探究使用大环内酯类抗菌药物联合解热止嗽汤治疗携带bla_(KPC-2)基因病原菌感染肺炎患儿的临床疗效.方法选择2018年5月-2019年5月浙江大学附属儿童医院长兴院区儿内科接受治疗的54例携带bla_(KPC-2)基因耐药菌感染肺炎患儿作为研究对象,按照治疗方式不同分为研究组和对照组,每组各27例.对照组患儿仅接受大环内酯类抗菌药物治疗,研究组患儿在此基础上加用解热止嗽汤进行治疗,对两组患儿的临床疗效和血清因子水平进行比较.结果54例肺炎患儿痰液标本共分离病原菌73株,其中肺炎克雷伯菌携带bla_(KPC-2)基因阳性率最高为86.21%;治疗后研究组患儿退热、肺部啰音消失、咳嗽消失及肺部阴影消失的时间均短于对照组;研究组患儿治疗疗效高于对照组患儿(Z=2.338,P=0.019);研究组患儿血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)以及肿瘤坏死因子-α(TNF-α)水平均低于对照组(P<0.05);研究组患儿不良反应总发生率低于对照组患儿(P<0.05).结论大环内酯类抗菌药物联合解热止嗽汤治疗携带bla_(KPC-2)基因病原菌感染肺炎患儿能够有效改善临床症状,降低炎症因子水平,产生不良反应的概率较小,安全性较高.OBJECTIVE To explore the clinical effect of macrolides antibiotics combined with jierezhisou Decoction on treatment of the children with pneumonia caused by pathogens carrying with bla_(KPC-2) gene.METHODS A total of 54 children with pneumonia caused by drug-resistant pathogens carrying with bla_(KPC-2) gene who were treated in the pediatrics department of Changxing District,Children′s Hospital Affiliated to Zhejiang University from May 2018 to May 2019 were recruited as the study subjects and divided into the study group and the control group,with 27 cases in each group.The control group was only treated with macrolides antibiotics,while the study group was given additional Jierezhisou Decoction on basis of the macrolides antibiotics.The clinical curative effect and serological indexes were observed and compared between the two groups of children.RESULTS Totally 73 strains of pathogens were isolated from sputum specimens of 54 children with pneumonia,the positive rate of bla_(KPC-2) gene in Klebsiella pneumoniae strains was the highest(86.21%).The time of disappearance of fever,lung rales,cough and lung shadows was shorter in the study group than in the control group after the treatment.The total effective rate of treatment of the study group was 92.59%,significantly higher than 77.78%of the control group(P<0.05).The levels of serum PCT,CRP,IL-6,IL-8 and TNF-αof the study group were lower than those of the control group(P<0.05).The total incidence of adverse reactions of the study group was lower than that of the control group(P<0.05).CONCLUSION Macrolide combined with jierezhisou decoction can effectively improve the clinical symptoms of the children with pneumonia caused by the pathogens carrying with bla_(KPC-2) gene and reduce the levels of inflammatory factors,with the incidence of adverse reactions low,the safety high.

关 键 词：bla_(KPC-2)基因 病原菌 大环内酯类抗菌药物 解热止嗽汤 

分 类 号：R563.1[医药卫生—呼吸系统]