多黏菌素B联合替加环素对泛耐药肺炎克雷伯菌所致肺炎的临床疗效  

Clinical efficacy of polymyxin B in combination with tigecycline in pneumonia caused by pan-drug resistant Klebsiella pneumoniae

作　　者：李迪彬 郝谦谦 令狐海瑞 董化江[2] 涂悦 Li Dibin;Hao Qianqian;Linghu Hairui;Dong Huajiang;Tu Yue(Neurointensive Care Unit,Beijing Chaoyang Integrative Medicine Emergency Medical Center,Beijing 100020,China;Logistics University of Chinese People's Armed Police Forces,Tianjin 300189,China)

机构地区：[1]北京朝阳中西医结合急诊抢救中心神经重症医学科,北京100020 [2]武警后勤学院,天津300189

出　　处：《国际生物医学工程杂志》2022年第1期31-35,共5页International Journal of Biomedical Engineering

基　　金：国家自然科学基金(81801240)。

摘　　要：目的探讨多黏菌素B联合替加环素治疗泛耐药肺炎克雷伯菌(PDR-KP)所致肺炎的临床疗效及安全性。方法回顾性分析2018年9月至2021年8月北京朝阳中西医结合急诊抢救中心神经重症医学科收治的因PDR-KP所致肺炎而使用多黏菌素B联合替加环素治疗的71例患者临床资料,根据治疗前、治疗第7天、治疗结束时患者临床症状及实验室等指标变化,评估多黏菌素B联合替加环素治疗的临床总有效率、细菌清除率和安全性。结果71例患者的治疗时间为8~14 d,均数为11 d。多黏菌素B联合替加环素治疗后,大部分患者的症状、体征、实验室检查及胸部CT检查结果显著改善。治疗第7天,有37例患者临床治疗有效,总有效率为52.1%(37/71);有41例获得细菌学清除,细菌清除率为57.7%(41/71)。治疗结束时,有51例患者临床治疗有效,总有效率为71.8%(51/71);56例获得细菌学清除,细菌清除率为78.9%(56/71)。与治疗第7天相比,治疗结束时患者的总有效率和细菌清除率均明显升高,差异均具有统计学意义(χ^(2)=5.86、7.32,P=0.016、0.007)。治疗期间有39.4%(28/71)的患者出现皮肤色素沉着。结论多黏菌素B联合替加环素可尝试作为PDR-KP所致肺炎的治疗选择,但尚需要更可靠的临床证据。Objective To investigate the clinical efficacy of injectable polymyxin B combined with tigecycline in pneumonia caused by pan-drug resistant Klebsiella pneumonia(PDR-KP).Methods The retrospective analysis utilized clinical data of 71 patients with PDR-KP admitted to the Neurointensive Care Unit of Beijing Chaoyang Integrative Medicine Emergency Medical Center between September 2018 and August 2021.All patients received injectable polymyxin B combined with tigecycline.The response rate,bacterial clearance rate,and safety of this therapeutic option were evaluated according to the clinical symptoms and biochemical parameters before treatment(baseline),7 days after the treatment,and at the end of the treatment.Results The treatment time of 71 patients ranged from 8 to 14 days,with an average of 11 days.The symptoms,signs,laboratory tests,and chest CT findings of most patients significantly improved after the treatment using polymyxin B combined with tigecycline.On the 7th day after the treatment,37 patients were clinically effective,with a total effective rate of 52.1%(37/71);41 patients obtained bacteriological clearance,with a bacterial clearance rate of 57.7%(41/71).At the end of treatment,51 patients were clinically effective,with a total effective rate of 71.8%(51/71);56 patients obtained bacteriological clearance,with a bacterial clearance rate of 78.9%(56/71).Compared with the results on the 7th day after the treatment,the total effective rate(χ^(2)=5.86,P=0.016)and bacterial clearance rate(χ^(2)=7.32,P=0.007)of patients at the end of treatment were significantly increased.Skin pigmentation occurred in 39.4%(28/71)of patients during the treatment.Conclusions Polymyxin B combined with tigecycline can be tried as a treatment option for pneumonia caused by PDR-KP,but more reliable clinical evidence is still needed.

关 键 词：多黏菌素B 替加环素 泛耐药肺炎克雷伯菌 临床疗效 安全性 

分 类 号：R446.5[医药卫生—诊断学]