铜绿假单胞菌感染高风险但病原学未检出的社区获得性肺炎早期抗生素降阶梯治疗的安全性研究  

Safety study of early antibiotic de-escalation therapy for community-acquired pneumonia with high risk of Pseudomonas aeruginosa infection but undetected etiology

作　　者：曾昭墩 韦明君 李艺田 黄培飞 黎子杰 夏虎[2] ZENG Zhaodun;WEI Mingjun;LI Yitian;HUANG Peifei;LI Zijie;XIA Hu(the People's Hospital of Huaiji County of Guangdong Province,Zhaoqing 526400;Zhujiang Hospital of Southern Medical University,Guangzhou 510280,China)

机构地区：[1]广东省怀集县人民医院,广东肇庆526400 [2]南方医科大学珠江医院,广东广州510280

出　　处：《临床医学研究与实践》2021年第24期45-47,共3页Clinical Research and Practice

基　　金：肇庆市科学技术局项目(No.202004030703)。

摘　　要：目的研究铜绿假单胞菌感染高风险但病原学未检出的社区获得性肺炎早期抗生素降阶梯治疗的安全性。方法选择2020年5月至2021年4月收治的60例铜绿假单胞菌感染高风险的社区获得性肺炎患者,随机将其分为基础组和观察组,每组30例。基础组采用常规抗感染方案治疗,观察组采用早期(48 h内)抗生素降阶梯治疗。观察两组的临床疗效、临床相关指标、CRP、PCT水平及不良反应发生情况。结果观察组的治疗总有效率为93.33%,显著高于基础组的73.33%(P<0.05)。观察组的抗生素使用时间、感染控制时间均短于基础组(P<0.05)。治疗后,两组的CRP、PCT水平均显著降低,且观察组低于基础组(P<0.05)。观察组的不良反应总发生率低于基础组(P<0.05)。结论针对铜绿假单胞菌感染高风险但病原学未检出的社区获得性肺炎患者,采用阿莫西林克拉维酸钾+阿奇霉素降阶梯治疗的效果优于广谱抗生素治疗,且安全性较高,值得应用。Objective To study the safety of early antibiotic de-escalation therapy for community-acquired pneumonia with high risk of Pseudomonas aeruginosa infection but undetected etiology.Methods A total of 60 patients with community-acquired pneumonia with high risk of Pseudomonas aeruginosa infection admitted from May 2020 to April 2021 were selected and randomly divided into basic group and observation group,with 30 cases in each group.The basic group was treated with routine anti-infection regimen,and the observation group was treated with early(within 48 h)antibiotic de-escalation therapy.The clinical efficacy,clinical related indexes,CRP and PCT levels and adverse reactions of the two groups were observed.Results The total effective rate of treatment in the observation group was 93.33%,which was significantly higher than 73.33% in the basic group(P<0.05).The antibiotic use time and infection control time in the observation group were shorter than those in the basic group(P<0.05).After treatment,the levels of CRP and PCT in the two groups significantly decreased,and those in the observation group were lower than the basic group(P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the basic group(P<0.05).Conclusion For patients with community-acquired pneumonia with high risk of Pseudomonas aeruginosa infection but undetected etiology,the effect of amoxicillin clavulanate potassium+azithromycin de-escalation therapy is better than broad-spectrum antibiotic therapy,with high safety,which is worthy of application.

关 键 词：社区获得性肺炎 抗生素降阶梯治疗 铜绿假单胞菌感染高风险 

分 类 号：R74[医药卫生—神经病学与精神病学]