多黏菌素B治疗多重耐药和泛耐药菌所致医院获得性肺炎老年患者的观察  

Polymyxins B in elderly patients with hospital acquired pneumonia induced by multidrug-resistant and extensively drug-resistant bacteria

作　　者：苏晶[1] 刘志青[1] 杨悦[1] 陈琳[1] SU Jing;LIU Zhi-qing;YANG Yue;CHEN Lin(Department of Geriatrics,Institute of Aging and Geriatrics,The Second Xiangya Hospital of Central South University,Changsha 410011)

机构地区：[1]中南大学湘雅二医院老年医学科,中南大学衰老与老年疾病研究所,长沙410011

出　　处：《中南药学》2023年第9期2487-2494,共8页Central South Pharmacy

摘　　要：目的观察多黏菌素B治疗多重耐药(MDR)和泛耐药(XDR)菌所致医院获得性肺炎老年患者的疗效及不良反应。方法回顾性分析2018年1月至2023年3月在中南大学湘雅二医院老年医学科和呼吸与危重症医学科收治的117例静脉滴注多黏菌素B治疗的MDR和XDR菌所致医院获得性肺炎老年患者,收集临床资料,根据临床治疗效果分为有效组和无效组,用Logistic回归分析影响老年肺炎患者疗效的因素;根据多黏菌素B治疗后是否出现急性肾损伤(AKI)分为AKI组和无AKI组,Logistic回归分析AKI的影响因素。结果117例患者,平均年龄(74.4±8.9)岁,53例治疗有效,有效率45.3%。高急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、鲍曼不动杆菌感染、使用血管活性药物、多黏菌素B疗程<7 d为疗效不佳的影响因素。不良反应主要为肾损伤(43例),AKI发生率为36.8%,高APACHEⅡ评分、多黏菌素B日剂量≥150 mg和基础血肌酐值是多黏菌素B治疗后出现AKI的危险因素。结论足疗程给药能够提高多黏菌素B治疗老年肺炎患者的有效率,多黏菌素B日剂量≥150 mg会增加肾损伤的风险。Objective To observe the clinical efficacy and side effect of polymyxins B in elderly patients with hospital acquired pneumonia induced by multidrug-resistant and extensively drugresistant bacteria.Methods Clinical data of 117 elderly patients with hospital acquired pneumonia Diseases treated with intravenous infusion of polymyxin B in the Department of Geriatrics and Department of Pulmonary and Critical Care of the Second Xiangya Hospital,Central South University from Jan 2018 to Mar 2023 were retrospectively analyzed.Patients were divided into an effective group and an ineffective group according to the therapeutic effect.Logistic regression was used to analyze the factors affecting the therapeutic effect of senile pneumonia patients.Patients were grouped according to whether there was acute kidney injury after polymyxin B treatment.Logistic regression analyzed the factors that affected the kidney function.Results The average age of 117 patients was(74.4±8.9)years old.The drug was effective in 53 patients(45.3%).High APACHEⅡscore,infection with acinetobacter baumannii,the use of vasoactive drugs and the course of polymyxin B less than 7 days were factors for less effective clinical treatment.Totally 43 patients(36.8%)experienced.High APACHEⅡscore,daily dose of polymyxin B≥150 mg and base serum creatinine value were independent risk factors for acute kidney injury after polymyxin B treatment.Conclusion Adequate treatment period of polymyxins B can improve the clinical efficacy in elderly patients with hospital acquired pneumonia,but daily dose of polymyxin B≥150 mg increases the risk of renal injury.

关 键 词：多黏菌素B 医院获得性肺炎 老年 疗效 不良反应 

分 类 号：R96[医药卫生—药理学]