替加环素与碳青霉烯类抗菌药物治疗多药耐药菌重症腹腔感染的临床疗效  

Clinical effect of tigecycline and carbapenems on treatment of severe intraabdominal infection caused by multidrug-resistant organisms

作　　者：陈新龙[1] 赵宏胜[1] 王林华[1] 陆洋[1] 孙晨靓[1] 陆舒[1] 彭清云[1] 黄莉莉[1] CHEN Xin-long;ZHAO Hong-sheng;WANG Lin-hua;LU Yang;SUN Chen-liang;LU Shu;PENG Qing-yun;HUANG Li-li(Affiliated Hospital of Nantong University,Nantong,Jiangsu226000,China)

机构地区：[1]南通大学附属医院重症医学科,江苏南通226000

出　　处：《中华医院感染学杂志》2021年第13期2001-2006,共6页Chinese Journal of Nosocomiology

基　　金：北京医卫健康公益基金会医学科学研究基金资助项目(YWJKJJHKYJJ-B17545)。

摘　　要：目的对比分析替加环素与碳青霉烯类抗菌药物治疗多药耐药菌(MDR)重症腹腔感染(sIAI)的临床疗效。方法选取2016年1月-2020年12月在南通大学附属医院重症医学科(ICU)收治的68例MDR sIAI患者,采用简单随机分组分为替加环素组(以替加环素为基础的联合用药)34例和碳青霉烯组(以碳青霉烯为基础的联合用药)34例,连续治疗≥3 d。分别于治疗前后,检测血清免疫球蛋白(Ig)G、IgA、IgM、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C-反应蛋白(CRP)和降钙素原(PCT)水平。治疗后,评估两组疗效,记录不良反应发生率和30 d内生存情况。结果替加环素组总有效率和病原菌清除率分别为76.47%和73.53%,碳青霉烯组总有效率和病原菌清除率分别为64.71%和61.76%,两组比较,无统计学差异;治疗后,替加环素组患者血清IgG和IgM水平均高于碳青霉烯组(P<0.05),血清IgA、TNF-α、IL-6、CRP和PCT水平低于碳青霉烯组(P<0.05);替加环素组患者治疗30 d生存率为73.53%,与碳青霉烯组的61.76%比较,无统计学差异;替加环素组不良反应发生率为17.65%,与碳青霉烯组的14.71%比较,无统计学差异。结论替加环素治疗可以明显提高MDR sIAI患者的免疫功能,降低炎症因子水平,其治疗有效率和细菌清除率与碳青霉烯类抗菌药物无明显差异。OBJECTIVE To observe and compare the clinical effect of tigecycline and carbapenems on treatment of severe intraabdominal infection(sIAI) caused by multidrug-resistant organisms(MDROs). METHODS A total of 68 patients with MDROs sIAI who were treated in intensive care unit(ICU) of the Affiliated Hospital of Nantong University from Jan 2016 to Dec 2020 were enrolled in the study and randomly divided into the tigecycline group with 34 cases(combined drug therapy based on tigecycline) and the carbapenem group with 34 cases( combined drug therapy based on carbapenems), both groups were treated for no less than 3 consecutive days. The levels of serum immunoglobulin(Ig) G, IgA, IgM, tumor necrosis factor-α(TNF-α),interleukin-6(IL-6), C-reactive protein(CRP) and procalcitonin(PCT) were detected before and after the treatment. After the treatment, the curative effects of the two groups were evaluated, and the incidence rate of adverse reactions and 30-day survival status were recorded. RESULTS The total effective rate and eradication rate of pathogens of the tigecycline group were respectively 76.47% and 73.53%, the total effective rate and eradication rate of pathogens of the carbapenem group were respectively 64.71% and 61.76%, and there were no significant differences between the two groups. The levels of serum IgG and IgM of the tigecycline group were significantly higher than those of the carbapenem group after the treatment(P<0.05);the levels of serum IgA, TNF-α, IL-6, CRP and PCT of the tigecycline group were significantly lower than those of the carbapenem group(P<0.05). The 30-day survival rate was 73.53% in the tigecycline group, 61.76% in the carbapenem group, and there was no significant difference. The incidence of adverse reaction ns was 17.65% in the tigecycline group, 14.71% in the carbapenem group, and there was no significant difference. CONCLUSION Tigecycline can remarkably boost the immune function of the patients with MDROs sIAI and reduce the levels of inflammatory factors, and there are no signif

关 键 词：替加环素 碳青霉烯类 多药耐药菌 重症腹腔感染 

分 类 号：R978.1[医药卫生—药品]