多黏菌素B治疗血液系统恶性肿瘤伴CRKP-BSI的临床观察  

Clinical observation of polymyxin B in the treatment of CRKP-BSI in patients with hematological malignancies

作　　者：李纳[1,2,3] 刘楠 张爱玲[1,2,3] 李丽 万鼎铭[4] 张晓坚 LI Na;LIU Nan;ZHANG Ailing;LI Li;WAN Dingming;ZHANG Xiaojian(Dept.of Pharmacy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Henan Provincial Key Laboratory of Precision Clinical Pharmacy,Zhengzhou 450052,China;Henan Provincial Precision Clinical Pharmacy Application and Transformation Engineering Research Center,Zhengzhou 450052,China;Dept.of Hematology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院药学部,郑州450052 [2]河南省精准临床药学重点实验室,郑州450052 [3]河南省精准临床药学应用与转化工程研究中心,郑州450052 [4]郑州大学第一附属医院血液科,郑州450052

出　　处：《中国药房》2023年第4期461-465,470,共6页China Pharmacy

基　　金：重大新药创制科技重大专项(No.2020ZX09201009)。

摘　　要：目的分析多黏菌素B治疗血液系统恶性肿瘤伴耐碳青霉烯类肺炎克雷伯菌(CRKP)-血流感染(BSI)的有效性和安全性。方法回顾性分析2019年9月-2021年6月于我院接受至少3 d多黏菌素B治疗的血液系统恶性肿瘤伴CRKP-BSI患者的资料。所有患者初始均采用以多黏菌素B+替加环素+碳青霉烯类药物为基础的三联治疗方案。结果共纳入10例患者,血培养检出11株CRKP,其中10株CRKP产肺炎克雷伯菌碳青霉烯酶(KPC),1株CRKP同时产KPC和金属β-内酰胺酶;9株对黏菌素敏感,7株对替加环素敏感,5株对阿米卡星敏感,2株对复方磺胺甲噁唑敏感。所有患者均伴有中性粒细胞减少,平均持续时间为(14.1±6.4)d;均表现为发热、寒颤、乏力。经治疗后,有6例患者治愈出院,4例患者因感染性休克治疗无效死亡;所有患者未发生多黏菌素B相关的严重不良事件。结论多黏菌素B可作为血液系统恶性肿瘤伴CRKP-BSI患者的治疗用药,治疗期间均未发生多黏菌素B相关的严重不良事件。OBJECTIVE To analyze the efficacy and safety of polymyxin B in the treatment of carbapenem-resistant Klebsiella pneumoniae(CRKP)-bloodstream infection(BSI)in patients with hematologic malignancies.METHODS The medical records of patients with hematologic malignancies with CRKP-BSI who received polymyxin B for at least 3 days in our hospital from September 2019 to June 2021 were retrospectively analyzed.All patients were initially treated with a triple therapy namely polymyxin B+tigecycline+carbapenems for anti-infection therapy.RESULTS A total of 10 patients were enrolled as the study subjects.Eleven strains of CRKP were cultured in blood,including 10 strains of CRKP produced Klebsiella pneumoniae carbapenemase(KPC)and 1 strain of CRKP produced both KPC and metal-beta-lactamase;9 strains were sensitive to colistin,7 strains were sensitive to tigecycline,5 strains were sensitive to amikacin and 2 strains were sensitive to compound sulfamethoxazole.All patients were accompanied by neutropenia,with an average duration of(14.1±6.4)days.They were all characterized by fever,chills and fatigue.After treatment,6 patients were cured and discharged,4 patients died of ineffective treatment of septic shock.No serious adverse events related to polymyxin B occurred in all patients.CONCLUSIONS Polymyxin B can be used as a therapeutic drug for CRKP-BSI in patients with hematological malignancies.No serious adverse event related to polymyxin B occurs during the treatment.

关 键 词：多黏菌素B 耐碳青霉烯类肺炎克雷伯菌 血液系统恶性肿瘤 血流感染 疗效 安全性 

分 类 号：R978.1[医药卫生—药品]