多黏菌素B治疗儿童重症耐碳青霉烯革兰阴性杆菌感染用药分析  

Drug analysis of polymyxin B in the treatment of severe carbapenem-resistant Gram-negative bacteria infection in children

作　　者：林良康 刘忠强[1] 乔莉娜[1] 李德渊[1] 张海洋 LIN Liangkang;LIU Zhongqiang;QIAO Lina;LI Deyuan;ZHANG Haiyang(Department of Pediatric Intensive Care Unit,West China Second University Hospital,Sichuan University,Key Laboratory of Birth Defects and Related Diseases of Women and Children,Sichuan University,Ministry of Education,Chengdu 610041,Sichuan,China)

机构地区：[1]四川大学华西第二医院儿童重症医学科出生缺陷与相关妇儿疾病教育部重点实验室,四川成都610041

出　　处：《临床儿科杂志》2023年第8期578-583,共6页Journal of Clinical Pediatrics

基　　金：四川省中央引导地方科技发展专项项目(No.2021ZYD0105)。

摘　　要：目的评价多黏菌素B治疗儿童耐碳青霉烯类革兰阴性杆菌(CRGNB)感染的疗效和安全性。方法回顾性分析2020年7月—2021年12月儿科重症监护病房收治确诊或高度怀疑CRGNB感染并使用多黏菌素B抗感染患儿的临床资料。结果纳入20例CRGNB患儿,男11例、女9例,中位年龄为3.4(0.6~8.9)岁,12例治愈,1例死亡。基础疾病以血液肿瘤系统疾病最多(30.0%)。感染标本检出主要为深部痰液或肺泡灌洗液(75.0%),其次为血液(10.0%)。耐碳青霉烯肺炎克雷伯菌为最常分离的微生物(35.0%,7/20),其次为耐碳青霉烯铜绿假单胞菌(30%,6/20);另有4例为多种CRGNB混合感染。所有患儿均采用多黏菌素B联合用药方式,以美罗培南为主(9例,45.0%),20例患儿均未观察到毒副反应。存在下呼吸道感染的15例患儿中,与单纯多黏菌素B静脉注射用药相比,增加局部雾化用药患儿的治愈率更高(P=0.002)。结论多黏菌素B治疗儿童CRGNB感染的疗效和安全性值得肯定,但目前亟需更多、更大规模的临床研究做进一步探索和评估。Objective To evaluate the efficacy and safety of polymyxin B in the treatment of carbapenem-resistant Gram-negative bacteria(CRGNB)infection in children.Methods From July 2020 to December 2021,32 cases of carbapenem-resistant Gram-negative bacteria infection in PICU with using polymyxin B were retrospectively analysed.Results 20 patients enrolled in the retrospective cohort,11 males and 9 females,with a median age of 3.4(0.6-8.9)years;12 were cured and 1 died.The underlying diseases were most frequently haemato-oncological system diseases(30.0%).Infection specimens from 20 patients were mainly detected in sputum or bronchoalveolar lavage fluid(75%),followed by blood(10%).Carbapenem-resistant Klebsiella pneumoniae was the most frequently isolated organism(35.0%,7/20),followed by carbapenem-resistant Pseudomonas aeruginosa with 30%(6/20).Another 4 cases were mixed infection of multiple carbapenem-resistant Gram-negative bacilli..All children were treated with a polymyxin B combination,with meropenem as the mainstay(9 cases,45.0%),and no adverse reactions were observed in 20 cases.Of the 15 children with lower respiratory tract infections,a higher cure rate was observed in children with the addition of topical nebulisation compared to the intravenous administration of polymyxin B alone(P=0.002).Conclusion The efficacy and safety of polymyxin B in the treatment of severe carbapenem-resistant Gram-negative bacterial infection in children is worthy of affirmation.However,more and large-scale clinical studies are urgently needed for further exploration and evaluation..

关 键 词：多重耐药 耐碳青霉烯革兰阴性杆菌 多黏菌素B 儿科重症监护病房 

分 类 号：R725[医药卫生—儿科]