以多黏菌素B为基础联合治疗耐碳青霉烯革兰阴性菌脓毒症的临床疗效分析  

Clinical efficacy of polymyxin B combination therapy in the treatment of carbapenem-resistant gram-negative bacteria sepsis

作　　者：王静[1] 辛绍斌[1] 孙强[1] 马旺[1] 齐勇[1] 王永明 申翔 WANG Jing;XIN Shaobin;SUN Qiang;MA Wang;QI Yong;WANG Yongming;SHEN Xiang(Department of Critical Care Medicine,Tianjin Union Medical Center,Tianjin 300121,China)

机构地区：[1]天津市人民医院重症医学科,300121

出　　处：《天津医药》2022年第1期88-93,共6页Tianjin Medical Journal

摘　　要：目的探讨以多黏菌素B为基础联合其他抗生素治疗耐碳青霉烯革兰阴性菌(CR-GNB)脓毒症患者的临床疗效。方法回顾性分析48例使用多黏菌素B为基础联合其他抗生素治疗CR-GNB感染的脓毒症患者的临床相关资料。(1)按照标本采集送检时间至开始使用多黏菌素B时间分组,分为早期组(≤7 d,30例)和推迟组(>7 d,18例)。(2)按照多黏菌素B治疗的持续用药时间分组,分为≤7 d组(16例)和>7 d组(32例)。(3)按照多黏菌素B联合其他抗生素治疗的用药方案不同分组,分为替加环素组(23例)、碳青霉烯组(9例)和其他药物组(哌拉西林他唑巴坦、头孢哌酮舒巴坦、环丙沙星、依替米星等,16例)。比较各组患者细菌总清除率、治疗有效率、28 d病死率的差异。结果(1)早期组治疗后细菌总清除率(76.7%vs.44.4%,χ2=5.107,P<0.05)和治疗有效率(73.3%vs.44.4%,χ2=4.006,P<0.05)均高于推迟组,28 d病死率比较差异无统计学意义(30.0%vs.38.9%,χ2=0.400,P>0.05)。(2)治疗持续时间>7 d组治疗后细菌总清除率(78.1%vs.37.5%,χ2=7.696,P<0.01)、治疗有效率(75.0%vs.37.5%,χ2=6.400,P<0.05)、28 d病死率(21.9%vs.56.3%,χ2=5.672,P<0.05)较≤7 d组明显改善。(3)多黏菌素B联合治疗用药方案中,替加环素组、碳青霉烯组和其他药物组之间的细菌总清除率(69.6%vs.66.7%vs.56.3%,χ2=0.823)、治疗有效率(69.6%vs.55.6%vs.56.3%,χ2=1.051),28 d病死率(26.1%vs.33.3%vs.43.8%,χ2=1.390)的比较,差异无统计学意义(均P>0.05)。结论对于CR-GNB感染致脓毒症患者,多黏菌素B应早期、足疗程地与其他抗感染药物联合使用,以利于患者获益更多。Objective To investigate the clinical efficacy of polymyxin B based combination therapy on patients with carbapenem-resistant gram-negative bacterial(CR-GNB) sepsis.Methods Clinical data of 48 patients with sepsis who used polymyxin B as the basis for combination therapy of CR-GNB infection were retrospectively analyzed.(1) According to the time from specimen collecting for inspection to the start of the use of polymyxin B,patients were divided into the early group(≤7 days,n=30) and the delayed group(>7 days,n=18).(2) According to the duration of polymyxin B therapy,patients were divided into the ≤7 days group(n=16) and the>1 days group(n=32).(3) According to the different combination of polymyxin B-based therapy,patients were divided into the tegacyclin group(n=23),the carbapenem group(n=9) and the other drug groups(piperacillin tazobactam,cefoperazone sulbactam,ciprofloxacin and etimicin,n=16).The total bacterial clearance rate,effective rate and 28-d mortality were compared between groups.Results(1) The total bacterial clearance rate(76.7% vs.44.4%,χ^(2)=5.107,P<0.05) and the efficacy rate(73.3% vs.44.4%,χ^(2)=4.006,P<0.05) after therapy were higher in the early group than those in the delayed group.There was no significant difference in the 28-day mortality between the two groups(30.0% vs.38.9%,χ^(2)=0.400,P>0.05).The total bacterial clearance rate(78.1% vs.37.5%,χ^(2)=7.696,P<0.01),efficacy rate(75.0% vs.37.5%,χ^(2)=6.400,P<0.05) and 28-day mortality(21.9% vs.56.3%,χ^(2)=5.672,P<0.05) were significantly improved in the therapy duration > 7-day group compared with the therapy duration ≤7-day group.(3) In the combination therapy of polymyxin B,total bacterial clearance rate(69.6% vs.66.1% vs.56.3%,χ^(2)=0.823),efficacy rate(69.6% vs.55.6% vs.56.3%,χ^(2)=1.051) and 28-day mortality(26.1% vs.33,3% vs.43,8%,χ^(2)=1.390) showed no significant difference between the tegacyclin group,the carbapenem group and the other drug groups(all P>0.05).Conclusion Polymyxin B should be used in combination with ot

关 键 词：脓毒症 多黏菌素B 耐碳青霉烯革兰阴性菌 联合治疗 临床疗效 

分 类 号：R453.2[医药卫生—治疗学] R515.3[医药卫生—临床医学]