头孢哌酮/舒巴坦联合替加环素治疗耐药鲍氏不动杆菌肺炎的临床效果  

Clinical effect of cefoperazone-sulbactam combined with tigecycline on treatment of carbapenem-resistant Acinetobacter baumannii pneumonia

作　　者：李佐鑫 谢慧[2] 曾妮[3] 高瑞 宋玮[1] 张莹 LI Zuo-xin;XIE Hui;ZENG Ni;GAO Rui;SONG Wei;ZHANG Ying(Tianjin Fifth Central Hospital,Tianjin 300450,China;不详)

机构地区：[1]天津市第五中心医院药剂科,天津300450 [2]广州医科大学附属第一医院药学部,广东广州510120 [3]天津市第五中心医院呼吸科,天津300450 [4]天津医科大学总医院滨海医院药剂科,天津300070

出　　处：《中华医院感染学杂志》2021年第20期3121-3125,共5页Chinese Journal of Nosocomiology

基　　金：广东省自然科学基金资助项目(2017A030313885)。

摘　　要：目的研究头孢哌酮/舒巴坦(CS)联合替加环素治疗耐药鲍氏不动杆菌(CRAB)肺炎的临床效果。方法回顾性分析2017年6月-2020年8月天津市第五中心医院收治的180例CRAB肺炎患者,根据治疗药物分为替加环素组(n=59)、米诺环素组(n=54)和左氧氟沙星组(n=67)。替加环素组采用替加环素联合CS治疗,米诺环素组采用米诺环素联合CS治疗,左氧氟沙星组采用左氧氟沙星联合CS治疗,三组均连续治疗≥7 d。分别于治疗前和治疗7 d后,检测血白细胞(WBC)计数、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)和降钙素原(PCT)水平,采用急性生理与慢性健康评分(APACHEⅡ)评估疾病严重程度。统计机械通气时间、感染控制窗出现时间、药物治疗时间和住院时间。结果三组治疗的总有效率和病原菌清除率比较,差异无统计学意义;替加环素组机械通气时间和感染控制窗出现时间短于米诺环素组(P<0.05),治疗后WBC、TNF-α、CRP、PCT水平和APACHEⅡ评分低于米诺环素组(P<0.05);米诺环素组机械通气时间和感染控制窗出现时间短于左氧氟沙星组(P<0.05),治疗后WBC、TNF-α、CRP、PCT水平和APACHEⅡ评分低于左氧氟沙星组(P<0.05)。结论相比于联合米诺环素、左氧氟沙星,CS联合替加环素治疗可以更有效控制CRAB肺炎患者的感染进展。OBJECTIVE To observe the clinical effect of cefoperazone/sulbactam(CS)combined with tigecycline on treatment of carbapenem-resistant Acinetobacter baumannii(CRAB)pneumonia.METHODS A total of 180 patients with CRAB pneumonia who were treated in Tianjin Fifth Central Hospital from Jun.2017 to Aug.2020 were retrospectively analyzed and were divided into the tigecycline group with 59 cases,the minocycline group with 54 cases and the levofloxacin group with 67 cases according the drugs.The tigecycline group was treated with tigecycline combined with CS,the minocycline group was treated with minocycline combined with CS,the levofloxacin group was treated with levofloxacin combined with CS,all of the three groups were treated for no less than 7 consecutive days.The levels of white blood cell(WBC),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and procalcitonin(PCT)were detected before the treatment and after the treatment for 7 days,the severity of disease was evaluated by using acute physiology and chronic health evaluation II(APACHEII);the mechanical ventilation duration,appearance time of infection control window,time of drug therapy and length of hospital stay were statistically analyzed.RESULTS There were no significant differences in the total effective rate of treatment and eradication rate of pathogens among the three groups.The mechanical ventilation duration and appearance time of infection control window of the tigecycline group were signigifcantly shorter than those of the minocycline group(P<0.05).The levels of WBC,TNF-α,CRP and PCT and APACHEⅡscore were signigifcantly lower in the tigecycline group than in the minocycline group after the treatment(P<0.05).The mechanical ventilation duration and appearance time of infection control window of the minocycline group were signigifcantly shorter than those of the levofloxacin group(P<0.05),the levels of WBC,TNF-α,CRP and PCT and APACHEⅡscore were signigifcantly lower in the minocycline group than in the levofloxacin group after the treatment(P<0.0

关 键 词：肺炎 耐碳青霉烯类鲍氏不动杆菌 替加环素 米诺环素 左氧氟沙星 

分 类 号：R563.1[医药卫生—呼吸系统]