多黏菌素B治疗粒细胞缺乏伴难治性革兰阴性菌血流感染27例临床观察  

Efficacy and safefy of Polymyxin B treatment for neutropenic patients suffering from refractory Gram-negative bacterial bloodstream infection

作　　者：周萌 康慧珠 顾骋圆 刘跃均[1] 王荧[1] 苗瞄[1] 付建红[1] 唐晓文[1] 仇惠英[1] 傅琤琤[1] 金正明[1] 李彩霞[1] 陈苏宁[1] 孙爱宁[1] 吴德沛[1] 韩悦[1] Zhou Meng;Kang Huizhu;Gu Chengyuan;Liu Yuejun;Wang Ying;Miao Miao;Fu Jianhong;Tang Xiaowen;Qiu Huiying;Fu Chengcheng;Jin Zhengming;Li Caixia;Chen Suning;Sun Aining;Wu Depei;Han Yue(The First Affiliated Hospital of Soochow University,Jiangsu Institute of Hematology,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health,National Clinical Research Center for Hematologic Diseases,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院,江苏省血液研究所,国家卫生健康委员会血栓及止血重点研究室,国家血液系统疾病临床医学研究中心,苏州215006

出　　处：《中华血液学杂志》2023年第6期484-489,共6页Chinese Journal of Hematology

摘　　要：目的观察多黏菌素B治疗粒细胞缺乏(粒缺)伴难治性革兰阴性菌血流感染的疗效和安全性。方法回顾性分析2021年8月至2022年7月在苏州大学附属第一医院血液科收治的粒缺伴难治性革兰阴性菌血流感染的病例,观察多黏菌素B治疗的疗效与安全性。结果共纳入27例粒缺伴难治性革兰阴性菌血流感染的血液病患者,其中22例多黏菌素B治疗有效,首次发热至给予多黏菌素B的中位间隔为3(2,5)d;多黏菌素B的中位用药时间为7(5,11)d,中位退热时间为37(32,70)h。其中4例发生急性肾功能损伤,占14.8%,根据RIFLE标准,均为"损伤(Injury)"级别;色素沉着发生率为59.3%。结论多黏菌素B治疗粒缺伴难治性革兰阴性菌血流感染具有较好的疗效和安全性。Objective To assess the efficacy and safety of polymyxin B in neutropenic patients with hematologic disorders who had refractory gram-negative bacterial bloodstream infection.MethodsFrom August 2021 to July 2022,we retrospectively analyzed neutropenic patients with refractory gram-negative bacterial bloodstream infection who were treated with polymyxin B in the Department of Hematology of the First Affiliated Hospital of the Soochow University between August 2021 to July 2022.The cumulative response rate was then computed.ResultsThe study included 27 neutropenic patients with refractory gram-negative bacterial bloodstream infections.Polymyxin B therapy was effective in 22 of 27 patients.The median time between the onset of fever and the delivery of polymyxin B was 3 days[interquartile range(IQR):2-5].The median duration of polymyxin B treatment was 7 days(IQR:5-11).Polymyxin B therapy had a median antipyretic time of 37 h(IQR:32-70).The incidence of acute renal dysfunction was 14.8%(four out of 27 cases),all classified as"injury"according to RIFLE criteria.The incidence of hyperpigmentation was 59.3%.ConclusionPolymyxin B is a viable treatment option for granulocytopenia patients with refractory gram-negative bacterial bloodstream infections.

关 键 词：多黏菌素B 粒缺期 难治性革兰阴性菌 血流感染 

分 类 号：R516[医药卫生—内科学]