头孢他啶/阿维巴坦在治疗碳青霉烯耐药革兰阴性杆菌感染的高龄医院获得性肺炎/呼吸机相关性肺炎患者中的临床应用经验  

Clinical experience of ceftazidime/averbactam for treatment of hospital-acquired pneumonia/ventilator-associated pneumonia caused by carbapenem-resistant organisms in patients with advanced age

作　　者：杨琤瑜[1] 李敏静[1] 周基安 龚瑾[1] 李向阳[1] 朱惠莉[1] Yang Chengyu;Li Minjing;Zhou Ji’an;Gong Jin;Li Xiangyang;Zhu Huili(Department of Pulmonary and Critical Care Medicine,Huadong Hospital Affiliated to Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华东医院呼吸与危重症医学科,上海200040

出　　处：《老年医学与保健》2022年第5期1086-1092,共7页Geriatrics & Health Care

摘　　要：目的 研究碳青霉烯耐药革兰阴性杆菌(carbapenem-resistant organisms,CRO)感染的高龄医院获得性肺炎/呼吸机相关性肺炎(hospital-acquired pneumonia/ventilator-associated pneumonia,HAP/VAP)患者中使用头孢他啶/阿维巴坦(Ceftazidime/avibactam,CAZ/AVI)治疗的临床疗效和不良反应。方法 本研究采用回顾性分析,纳入复旦大学附属华东医院2019年10月—2021年5月期间因CRO感染而接受CAZ/AVI治疗的高龄HAP/VAP患者。研究者收集并分析患者的临床和微生物学资料。结果 本研究共纳入22例患者,中位年龄是95岁。17例(77.3%)患者的痰培养结果显示病原菌是耐碳青霉烯类肺炎克雷伯菌,另5例为耐碳青霉烯类铜绿假单胞菌。其中,17株菌株进行了CAZ/AVI的药敏检测,有11株(64.7%)敏感。在接受CAZ/AVI治疗时,19例(86.4%)患者合并使用其它抗革兰阴性杆菌抗生素,合并使用最多的是美罗培南(n=13/19)。CAZ/AVI的平均疗程为13.8 d。在所有接受CAZ/AVI治疗的患者中,有90.9%(n=20/22)的患者达到细菌清除,其中8例(42.1%)发生了复燃。有68.2%(n=15/22)的患者达到了临床有效。所有患者的30 d死亡率为9.1%。在CAZ/AVI治疗期间,有3例患者(17.6%)存在急性肾损伤。结论 本研究结果初步显示了CAZ/AVI在高龄HAP/VAP中的临床疗效和安全性。需要更多的研究来进一步优化该药在高龄重症感染患者中的治疗方案。Objective To investigate the clinical efficacy and adverse events of ceftazidime/avibactam(CAZ/AVI) in the treatment of hospital-acquired pneumonia/ventilator-associated pneumonia(HAP/VAP) caused by carbapenem-resistant organisms(CRO) in patients with advanced age.Methods A retrospective analysis was performed in patients of advanced age who received CAZ/AVI treatment for HAP/VAP caused by CRO in Huadong Hospital Affiliated to Fudan University from October 2019 to May 2021.The clinical and microbiological data were collected and analyzed.Results A total of 22 patients with a median age of 95 years were enrolled.Sputum cultures showed that 17 patients(77.3%) were infected with carbapenem-resistant Klebsiella pneumoniae and the other 5 patients were infected with carbapenem-resistant Pseudomonas aeruginosa.Seventeen isolates were tested for susceptibility to CAZ/AVI,and 11 isolates(64.7%) were susceptible.CAZ/AVI was administered as combination therapy with other antibiotics against gram-negative bacilli in 86.4%(n=19/22) of the patients,and meropenem was the most common agent(n=13/19).The average course of CAZ/AVI treatment was 13.8 days.Microbiological cure was achieved in 90.9%(n=20/22) of the patients,and 8(42.1%) of them relapsed.Clinical success was achieved in 15 patients(68.2%).The 30-day mortality rate was 9.1%.During CAZ/AVI treatment,3 patients(17.6%) developed acute kidney injury.Conclusion The study preliminarily presented the clinical efficacy and safety of CAZ/AVI in patients of advanced age with HAP/VAP.Further studies of CAZ/AVI in those patients with severe infection are required to optimize the therapeutic regimens.

关 键 词：高龄 碳青霉烯耐药革兰阴性杆菌 医院获得性肺炎/呼吸机相关性肺炎 头孢他啶/阿维巴坦 

分 类 号：R563.1[医药卫生—呼吸系统] R446.5[医药卫生—内科学]